Ileal perforation caused by a fish bone shortly after drug-eluting stent implantation for acute myocardial infarction.

Authors:
Jian-jiang Xu
Jian-jiang Xu
Eye Ear Nose and Throat Hospital of Fudan University
China
Li Xu
Li Xu
Renji Hospital
China
Zhong-Cheng Zhou
Zhong-Cheng Zhou
Howard University
United States
Li-qin Jiang
Li-qin Jiang
Eye Hospital
China

J Int Med Res 2019 Jun 24;47(6):2709-2715. Epub 2019 Apr 24.

1 Department of Cardiology, The Second Affiliated Hospital of Jiaxing University, Jiaxing, ZheJiang Province, China.

During the past century, the incidence of myocardial infarction has markedly increased worldwide. Percutaneous coronary intervention with stent implantation is often considered as the first-choice treatment, especially in emergency cases. Current guidelines recommend delayed elective noncardiac surgery for such vulnerable patients. However, few suggestions are available regarding the exact treatment strategy for patients who have already undergone percutaneous coronary intervention but suddenly need emergent noncardiac surgery for an unrelated reason. We herein present a case involving a patient with acute myocardial infarction who had undergone implantation of a drug-eluting stent and developed an ileal perforation due to fish bone ingestion 3 days postoperatively. After carefully balancing the risks of stent thrombosis and uncontrollable bleeding, dual antiplatelet therapy and low-molecular-weight heparin were given with close monitoring. Emergency laparotomy and partial small bowel resection surgery were then performed, after which the patient eventually recovered. This case indicates a possible management strategy for patients with acute myocardial infarction complicated by emergency noncardiac surgery.

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Source
http://dx.doi.org/10.1177/0300060519842778DOI Listing
June 2019
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