Extensive gangrene of the bowel after haemorrhagic shock: a case report.

A 20-year-old man presented with an acute abdominal condition within 15 hours after having sustained severe extra-abdominal injuries with associated hypovolaemic shock. At laparotomy virtually the whole bowel was found to be ischaemic and perforation had occurred at the site of maximum ischaemia. No trauma to the bowel, mesenteric vessels or any other abdominal organ was noted, and it was concluded that the ischaemia had resulted from a prolonged splanchic vasospasm in an attempt to compensate for hypovolaemic shock. The condition is well recognized in animals, but has rarely been recorded in humans. Early resuscitation of the shocked patient is mandatory in order to prevent not only renal shutdown but also mesenteric ischaemia. It is possible that some patients who suffer from 'irreversible shock' may develop endotoxaemia owing to the absorption of toxins from partially ischaemic bowel which does not proceed to frank gangrene.