TY - JOUR
AR - AJSCR-2023-4-102
TI - Rare Emergency Case of Bowel Ischaemia as a Result of Diabetic Ketoacidosis Complication: A Case Report and Literature Review of an Unusual Entity
AU - Athary, Saleem
AU - Saqer, Alenezi
AU - Jumana, Alfadhli
AU - Fahad, Alhammadi
AU - Maher, Hassan
AU - Khaled, Alshammari
JO - American Journal of Surgical Case Reports
PY - 2023
DA - Sat 30, Dec 2023
SN - 2674-5046
DO - http://dx.doi.org/10.31487/j.AJSCR.2023.04.02
UR - https://www.sciencerepository.org/rare-emergency-case-of-bowel-ischaemia_AJSCR-2023-4-102 
KW - Bowel ischaemia, diabetic ketoacidosis, small bowel resection, non-occlusive mesenteric ischaemia, laparotomy, case report
AB - Introduction and Importance: Diabetic ketoacidosis (DKA) is a life-threatening situation that if inadequately managed, is related to high fatality risk. It is associated with mesenteric ischaemia that necessitates early detection and intervention to enhance the prognosis for mesenteric ischaemia. 
Case Presentation: A 58-year-old male patient presented to our hospital with severe generalized abdominal pain, vomiting, and polyurea. On admission, he was newly diagnosed with diabetes mellitus type II (DM II) which is complicated by DKA. Days later, his abdominal pain worsened, and bowel obstruction was confirmed by both X-ray and ultrasonography of the abdomen. Due to the deterioration in the patient’s clinical condition, an emergent diagnostic laparoscopy was decided which was followed by an open laparotomy with bowel resection of the detected dilated and ischaemic bowel loops. The resected specimens, including small bowel and peritoneal wall mass, were sent for histopathological studies. Three re-look laparotomies were also performed, and the postoperative period was uneventful. 
Clinical Discussion: Intestinal ischaemia is a rare complication of DKA. Bowel ischaemia can be either occlusive or nonocclusive mesenteric types. It is clinically manifested by abdominal symptoms in diabetic patients. Evaluation is mainly by abdominal computed tomography (CT) and the main treatment approach is laparoscopy and/or laparotomy in combination with resection of the affected bowel loops.
Conclusion: In our case report, we document an additional unusual case of intestinal ischaemia and necrosis as a DKA consequence, in a recently diagnosed DM II patient, as one of the few non-occlusive mesenteric ischaemia causes.