Darmnecrose bij een patiënt met fibromusculaire dysplasie en digoxine-intoxicatie

– A woman aged 68 was admitted to our hospital in very poor condition. She complained of pain in the abdomen, anorexia, nausea and vomiting during the last 5 weeks. These complaints had become worse three days before admission. She appeared to have a digoxin intoxication. We considered mesenteric thrombosis, and an abdominal angiography was performed. Serious narrowing and occlusions of the mesenteric arterial system were seen. The patient died 10 hours after admission. At autopsy necrosis of almost the entire duodenum, jejunum, and ileum was found. There was no evidence of thrombi or emboli, nor was atherosclerosis of the larger arteries present. Some of the small mesenteric arteries were narrowed by fibromuscular dysplasia. Probably, the ischaemia was the result of arterial spasms caused by digoxin, reducing the flow that was already compromised by fibromuscular dysplasia.