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<p>Mesenteric traction syndrome (MTS) is a transient circulatory disturbance characterized by sudden hypotension, tachycardia, and facial flushing following mesenteric manipulation during abdominal surgery. Early recognition is essential; however, conventional monitoring often detects these events only after hemodynamic deterioration. We report a 68-year-old man who underwent distal pancreatectomy and splenectomy under combined general and thoracic epidural anesthesia. Sixteen minutes after the start of surgery, the hypotension prediction index (HPI)—an artificial intelligence–based monitoring system—abruptly increased to &gt; 85 despite stable vital signs. The systemic vascular resistance index decreased, suggesting early vasodilatory change. Prompt intravenous phenylephrine boluses were administered, and rapid colloid infusions were initiated to minimize hypotension. Recognition of facial flushing subsequently confirmed the diagnosis of MTS, and intravenous flurbiprofen stabilized the circulation. This case suggests that HPI monitoring may assist in the early identification of vasodilatory changes associated with MTS and support timely intervention before severe hypotension develops.</p>

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Early detection and management of mesenteric traction syndrome using the hypotension prediction index: a case report

  • 期刊论文

  • 出版模式：

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  • 发表日期：

    2025年12月2日

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  • Rui Yajima,
  • Takayuki Sugai,
  • Kei Inoue,
  • Takashi Ouchi,
  • Toshiya Koitabashi

摘要

Mesenteric traction syndrome (MTS) is a transient circulatory disturbance characterized by sudden hypotension, tachycardia, and facial flushing following mesenteric manipulation during abdominal surgery. Early recognition is essential; however, conventional monitoring often detects these events only after hemodynamic deterioration. We report a 68-year-old man who underwent distal pancreatectomy and splenectomy under combined general and thoracic epidural anesthesia. Sixteen minutes after the start of surgery, the hypotension prediction index (HPI)—an artificial intelligence–based monitoring system—abruptly increased to > 85 despite stable vital signs. The systemic vascular resistance index decreased, suggesting early vasodilatory change. Prompt intravenous phenylephrine boluses were administered, and rapid colloid infusions were initiated to minimize hypotension. Recognition of facial flushing subsequently confirmed the diagnosis of MTS, and intravenous flurbiprofen stabilized the circulation. This case suggests that HPI monitoring may assist in the early identification of vasodilatory changes associated with MTS and support timely intervention before severe hypotension develops.