Intestinal Fatty Acid Binding Protein as a Predictor of Early Mesenteric Injury Preceding Clinical Presentation: A Case Report

Introduction Diagnosing non-occlusive mesenteric ischaemia (NOMI) in patients is complicated, due to poor signs and symptoms and non-specific laboratory tests, leading to high mortality. This case study presents a rare case of a patient who developed mesenteric ischaemia after an emergency thoracic endovascular aneurysm repair (TEVAR) for a type B aortic dissection (TBAD) and peri-operative cardiogenic shock. Study outcomes revealed that intestinal fatty acid binding protein (I-FABP) identified early mucosal damage 2 days before clinical presentation. Report A 43 year old male patient was admitted to the emergency department with an acute TBAD and a dissection of the superior mesenteric artery (SMA), for which TEVAR was performed with additional stent placement in the SMA. Peri-operatively, the patient went into cardiogenic shock with a sustained period of hypotension. Post-operatively, the plasma I-FABP levels were prospectively measured, revealing an initial increase on post-operative day 5 (551.1 pg/mL), which continued beyond day 6 (610.3 pg/mL). On post-operative day 7, the patient developed a fever and demonstrated signs of intestinal peritonitis and bowel perforation. He underwent an emergency laparotomy, followed by an ileocaecal resection (< 100 cm) with a transverse ileostomy placement. Pathological analysis confirmed the diagnosis of mesenteric ischaemia. Discussion The diagnosis of NOMI in critically ill patients is often complicated, and the currently available diagnostic markers lack specificity and sensitivity to detect early intestinal injury. This case report highlights that elevated I-FABP in plasma levels may indicate the presence of early mesenteric injury. Further research needs to be conducted before I-FABP can be applied in daily practice.