Nonocclusive mesenteric ischemia following multiple wasp stings.

Massive wasp envenomation can cause not only severe immediate allergic reactions and anaphylaxis but also severe delayed toxin-mediated systemic reactions, including hemolysis, coagulopathy, rhabdomyolysis, acute renal failure, and hepatotoxicity. However, reports of the latter type of reactions are rare. The subject of this case report, a 66-year-old man, was stung more than 30 times during an attack by wasps. Although he initially complained of pain, he showed no signs of anaphylaxis during observation in an emergency department. Twenty hours after envenomation, he was admitted to the hospital because of vomiting, abdominal pain, and lower gastrointestinal bleeding. Mesenteric ischemia, rhabdomyolysis, acute renal failure, and hepatotoxicity were diagnosed as delayed toxin-mediated systemic reactions resulting from massive wasp envenomation. Contrast-enhanced computed tomography findings, which included no thrombi or emboli but did reveal the abrupt tapering of mesenteric arteries, strongly suggested that the ischemia was due to nonocclusive mesenteric ischemia. Immediately after diagnosis, an emergency laparotomy was performed. Nonocclusive mesenteric ischemia was finally diagnosed via a histologic examination of the resected small bowel. We present the first case report of nonocclusive mesenteric ischemia consequent to wasp stings.