[HSF] Acute abdomen plus unstable LM stenosis

[Ben Bidstrup]

>70yr male with unremarkable past history presented with acute 
>abdomen and rest angina. ( WCC 20,000 )
>Urgent cath showed subtotal LM, 90% LAD, normal dominant RCA, good 
>LV function.
>Balloon placed and emergent cabg ( opcab rima to LAD and lima to OM.)
>Laparotomy next day revealed dead colon which was successfully 
>resected but patient fading fast with septic shock despite 
>haemofiltration.
>
>Q1. Cause of dead gut in the absence of AF or infarct?
>Q2. Timing of laparotomy : before, during or sooner after cabg?
>Don
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Acute abdo - autopsy findings wrt gut vasculature??

A1. Acute gut problem - endotoxaemia - high output state - angina - 
CABG - increasing gut ischaemia - downward spiral.  What was lactate 
and LDH etc prior to CABG?
A2. OPCAB and extend incision - after all OPCAB is not a big deal - 
arteries ischaemia are fixed immediately.
-- 
Ben Bidstrup FRACS FRCSEd FEBCTS
Consultant Cardiothoracic Surgeon