Mesenteric Ischemia Revealing a Patent Foramen Ovale (PFO): Case Report and Literature Review

Digestive ischemia is rare among all acute ischemias. It is even rarer when its origin is a paradoxical embolism. Paradoxical embolism is an important clinical entity in patients with venous thromboembolism and the presence of cardiac or pulmonary shunts. The clinical manifestations are serious but diverse and sometimes make the diagnosis difficult. The advent of transesophageal ultrasound (TEE) has greatly facilitated the detection of patent foramen ovale (PFO). Given the diagnostic and therapeutic interest of this apparently rare manifestation, we report the observation of a young patient aged 20, with the initials AB, recently delivered one month, admitted to the surgical emergency department of the national hospital of Niamey (HNN) for diffuse abdominal pain. The clinical evaluation allowed the diagnosis of acute generalized peritonitis. The anesthesiological evaluation classified her as ASA 1 U. In the operating room, after rapid sequence induction followed by orotracheal intubation, opening the abdominal cavity allowed the aspiration of approximately 300 cc of peritoneal fluid and the discovery of a mesenteric infarction involving the loops from 10 cm from the ileocecal junction to 90 cm from the ileocecal junction. Elsewhere, the exploration was unremarkable. The procedure performed was a segmental resection, end-to-end small intestine anastomosis and the patient was transferred to the continuing care services for continued care. Given this atypical picture, hypotheses were raised as part of an etiological search. Thus, we thought of a paradoxical embolism given the notion of recent childbirth, which is a risk factor for venous thromboembolic disease, and familial dyslipidemia. The lipid profile was normal but cardiac Doppler ultrasound revealed a 4mm diameter interatrial communication with right-to-left shunt (PFO). The final diagnosis was that of a paradoxical embolism through a patent foramen ovale leading to mesenteric ischemia. The outcome ....