Persistent Hypotension and Cerebral Swelling Resulting From Mesenteric Traction Syndrome After Omental-to-Pial Pedicle Flap Transfer in a Young Woman With Refractory Moyamoya Disease: A Case Report. Issue 6 (15th September 2017)

• Record Type: Journal Article
• Authors: Woehlck, Harvey J.; Gollapudy, Suneeta; Roberts, Christopher J.; Oni-Orisan, Akinwunmi; Sacho, Raphael H.; Pagel, Paul S.
• Is Part Of: A & A case reports. Volume 9:Issue 6(2017:Sep. 15)
• Publication Date: 2017-09-15
• Subjects: Anesthesiology -- Periodicals; Anesthesia -- Periodicals; Anesthesiology; Analgesia; Anesthesiology; Periodicals; 617.9605
• DOI: 10.1213/XAA.0000000000000557
• Languages: English
• ISSNs: 2325-7237

Abstract

Abstract : Superficial temporal arterial to middle cerebral arterial anastomosis is often the initial surgical treatment of Moyamoya disease. In refractory cases, placing a pedicle flap of omentum over the ischemic brain has resulted in clinical improvement or stabilization of symptoms. We present a case of persistent mesenteric traction syndrome manifested by hypotension unresponsive to conventional doses of vasopressors during and after pulling the omentum to the brain. As prostacyclin is a major mediator of hypotension from mesenteric traction syndrome and also a cerebral vasodilator, we discuss the possibility that brain swelling may be a manifestation of mesenteric traction syndrome.