Upper Limb Ischemia in Preterm Infant Leading to Autoamputation of Hand – a Case Report


Upper Limb Ischemia in Preterm Infant Leading to Autoamputation of Hand – a Case Report


Karandeep singh ,Sarataj Singh, Amarjit Singh

Baba Farid University of Health and Sciences Faridkot , Punjab, India


Acute limb ischemia(ALI) in a paediatric patient is a rare condition but may result in limb loss and life long complications. We present here a case of a 34 weeks premature infant, with birth weight 1530 grams, who was having respiratory distress at time of birth. Infant was referred to advanced pediatric center for further management, where he was kept in neonatal ICU. He was put on C-PAP and oxygen support and an infant feeding tube for feeding. On 21st day infant developed ischemia of the right upper limb. Color Doppler flow study was done which revealed thrombosed right radial and ulnar artery and biphasic flow in brachial artery. He was put on low molecular weight heparin and was advised referral to higher center for further management. Patient developed dry gangrene of right hand and wrist resulting in the autoamputation of the hand and wrist after a period of 15 day from development of gangrene. In order to prevent such complications there should well trained staff to detect early ischemic changes in the limb so that timely treatment can be started and the long term chronic complications can be prevented.


Keywords: Premature infant, Acute limb ischemia, Gangrene, Complications.

Free Full-text PDF


How to cite this article:

Karandeep singh ,Sarataj Singh, Amarjit Singh. Upper Limb Ischemia in Preterm Infant Leading to Autoamputation of Hand – a Case Report. International Journal of Case Reports, 2021 5:253. DOI: 10.28933/ijcr-2021-09-1706


References:

1. Labbe R, Lindsay T, Walker PM. The extent and distribution of skeletal muscle necrosis after graded periods of complete ischemia. Journal of vascular surgery. 1987 Aug 1;6(2):152-7.
2. Callum K, Bradbury A. ABC of arterial and venous disease. BMJ. 2000;320:764-7.
3. Coombs CJ, Richardson PW, Dowling GJ, Johnstone BR, Monagle P. Brachial artery thrombosis in infants: an algorithm for limb salvage. Plastic and reconstructive surgery. 2006 Apr 15;117(5):1481-8.
4. Lazarides MK, Georgiadis GS, Papas TT, Gardikis S, Maltezos C. Operative and nonoperative management of children aged 13 years or younger with arterial trauma of the extremities. Journal of vascular surgery. 2006 Jan 1;43(1):72-6.
5. Matos JM, Fajardo A, Dalsing MC, Motaganahalli R, Akingba GA, Murphy MP. Evidence for nonoperative management of acute limb ischemia in infants. Journal of vascular surgery. 2012 Apr 1;55(4):1156-9.
6. Price V, Massicotte MP. Arterial thromboembolism in the pediatric population. In Seminars in thrombosis and hemostasis 2003;29(06): 557-66.
7. Monagle P, Chan AK, Goldenberg NA, Ichord RN, Journeycake JM, Nowak-Göttl U, Vesely SK. Antithrombotic therapy in neonates and children: antithrombotic therapy and prevention of thrombosis: American College of Chest Physicians Evidence-Based Clinical Practice Guidelines. Chest. 2012 Feb 1;141(2):e737S-801S.
8. Kayssi A, Shaikh F, Roche-Nagle G, Brandao LR, Williams SA, Rubin BB. Management of acute limb ischemia in the pediatric population. Journal of vascular surgery. 2014 Jul 1;60(1):106-10.
9. Arshad A, McCarthy MJ. Management of limb ischaemia in the neonate and infant. European Journal of Vascular and Endovascular Surgery. 2009 Jul 1;38(1):61-5.
10. Seu S, Chin EN and Brown MJ. Complication after unintentional intra arterial infection of drugs: risk outcome and management strategies. Mayo Clinic Proceeding. 2005; 80:783-95.
11. Kumar M, Singh J, Sharma P, Khera A, Singh P. Accidental Intra-Arterial Injection of Diclofenac–Case Report. Journal of clinical and diagnostic research: JCDR. 2015 Jan;9(1):PD16.
12. Dasgupta M, Adhikari S and Datta M. Inadvertent intra-articular injection leading to gangrene. A rare but devastating postoperative complication. J Obstet Gynaecol Ind 2012;62;56-8.
13. Nakhostine NA, Lamontagne DA. Adenosine contributes to hypoxia-induced vasodilation through ATP-sensitive K+ channel activation. American Journal of Physiology-Heart and Circulatory Physiology. 1993 Oct 1;265(4):H1289-93.
14. Singh A, Sidhu KS, Rai S. Accidental Intra-Arterial Injection during Test Dose of Injection of Benzyl Penicillin: Complications and Management—A Case Report. Case Reports in Clinical Medicine. 2015;4(06):222.


Terms of Use/Privacy Policy/ Disclaimer/ Other Policies:
You agree that by using our site, you have read, understood, and agreed to be bound by all of our terms of use/privacy policy/ disclaimer/ other policies (click here for details).



This work and its PDF file(s) are licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.