Acute lower limb ischemia secondary to diffuse peritonitis

Abstract

Background: Acute lower limb ischemia is generally caused by embolism, thrombosis, and traumatic injuries. However, patients with acute limb ischemia secondary to other underlying disease constitute a separate group. Case presentation: In this paper, we describe a case report of a 72-year-old woman, who was hospitalized with acute right lower limb ischemia to the Clinic of Vascular Surgery. According to past medical history, one day before hospitalization, the patient was examined by a surgeon for abdominal pain without signs of peritonitis. An abdominal ultrasound that did not reveal any pathology was performed; laboratory tests, that indicated an increase in white blood cell count to 18.2 × 109/L, were carried out. Next day, the patient consulted the vascular surgeon as she experienced severe right lower limb pain, numbness. Considering abdominal pain and elevated white blood cell count, there was performed emergency CT angiography that detected pneumoperitoneum and acute arterial occlusion of the right lower limb. There was performed concurrent emergency surgery: thrombectomy of the lower limb arteries and laparotomy that revealed gastrointestinal perforation, diffuse peritonitis. Unfortunately, the patient died due to hemodynamic deterioration and the development of multiple organ failure. Conclusion: This case report represents the development of acute lower limb ischemia as a complication of acute diffuse peritonitis. Septic shock resulted in the patient s dehydration, impaired blood coagulation parameters, and the development of secondary right lower extremity artery thrombosis.