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Review
. 2022 Jul 14:13:900325.
doi: 10.3389/fendo.2022.900325. eCollection 2022.

Non-Occlusive Mesenteric Ischemia in Children With Diabetic Ketoacidosis: Case Report and Review of Literature

Giulio Frontino  1   2 , Raffaella Di Tonno  1   2 , Valeria Castorani  1   2 , Andrea Rigamonti  1   2 , Elisa Morotti  1   2 , Federica Sandullo  1   2 , Francesco Scialabba  1   2 , Francesca Arrigoni  1   2 , Riccardo Foglino  1   2 , Benedetta Dionisi  1   2 , Chiara Irene Carla Ferri  1 , Salvatore Zirpoli  3 , Graziano Barera  1 , Franco Meschi  1   2 , Riccardo Bonfanti  1   2   4
Affiliations
Review

Non-Occlusive Mesenteric Ischemia in Children With Diabetic Ketoacidosis: Case Report and Review of Literature

Giulio Frontino et al. Front Endocrinol (Lausanne). .

Abstract

Introduction: Despite the use of technology, recurrent diabetic ketoacidosis (DKA) prevention remains an unmet need in children and adolescents with T1D and may be accompanied by life-threatening acute complications. We present a rare case of non-occlusive mesenteric ischemia (NOMI) with overt manifestation after DKA resolution and a discussion of recent literature addressing DKA-associated NOMI epidemiology and pathogenesis in children and adolescents.

Case presentation: A 13-year-old female with previously diagnosed T1D, was admitted at our emergency department with hypovolemic shock, DKA, hyperosmolar state and acute kidney injury (AKI). Mildly progressive abdominal pain persisted after DKA correction and after repeated ultrasound evaluations ultimately suspect for intestinal perforation, an intraoperative diagnosis of NOMI was made.

Conclusion: The diagnosis of DKA-associated NOMI must be suspected in pediatric patients with DKA, persistent abdominal pain, and severe dehydration even after DKA resolution.

Keywords: DKA (diabetic ketoacidosis); T1DM (type 1 diabetes mellitus); acute kidney injury; hyperosmolar (hyperglycemic) coma; insulin pump (CSII: continuous subcutaneous insulin infusion); non-occlusive mesenteric ischemia (NOMI).

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Conflict of interest statement

The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

Figures

Figure 1
Figure 1
(A) Abdomen ultrasound showing an encapsulated abscess between bladder and uterus (arrow). (B–E) Abdomen MRI showing a pelvic large fluid-filled abscess (arrows) with air bubbles such as for bowel perforation (B–D: T2 weighted) with parietal contrast enhancement (E: T1 weighted) and normal adnexal region (arrowheads).
Figure 2
Figure 2
Non-occlusive mesenteric ischemia in DKA. Created with BioRender.com.
See this image and copyright information in PMC

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