title: Bowel Ischemia in Refractory Status Epilepticus: Report of Two Cases and Review of the Literature.
abstract: BACKGROUND
  Bowel ischemia is a rare life threatening complication seen in patients with refractory status epilepticus (RSE). The few reported cases of bowel ischemia in this setting have been associated with the use continuous barbiturate infusions. We report two patients with RSE in the absence of barbiturate infusion and without clear structural, infectious, anatomic, vascular, or autoimmune etiology. We review the clinical details of the cases and potential factors involved in the development of non-occlusive bowel ischemia in patients with RSE.
  
  
  METHODS
  The following is a retrospective review of two cases of non-occlusive mesenteric ischemia that occurred during the management of RSE. The clinical data and the details of pathological examination of the infarcted segments of bowel are presented in both cases.
  
  
  RESULTS
  In both cases, the bowel ischemia occurred in the absence of barbiturate infusion or evidence of clear thrombosis, infection, or autoimmune etiology. Case 1 had extensive ischemic necrosis of the small bowel with secondary pseudomembrane formation, and case 2 had full thickness infarction of both the large and small bowel.
  
  
  CONCLUSIONS
  The mechanism of bowel infarction in these cases is likely multifactorial and was not associated with barbiturate use. Likely contributors to ischemia include RSE itself, systemic hypotension, vasopressor use, general anesthesia, and abnormal cardiac function. During the management of RSE, every effort must be made to avoid the secondary complications such as bowel ischemia.
authors.affiliation: Department of Clinical Neurological Sciences, Western University, London, ON, Canada. philippe.rizek@londonhospitals.ca.
authors.forename: P
authors.initials: P
authors.lastname: Rizek
authors.affiliation: Department of Clinical Neurological Sciences, Western University, London, ON, Canada. kristin.ikeda@londonhospitals.ca.
authors.forename: K M
authors.initials: KM
authors.lastname: Ikeda
authors.affiliation: Department of Surgery, Western University, London, ON, Canada. tina.mele@lhsc.on.ca.|Department of Critical Care Medicine, Western University, London, ON, Canada. tina.mele@lhsc.on.ca.
authors.forename: T
authors.initials: T
authors.lastname: Mele
authors.affiliation: Department of Pathology, Western University, London, ON, Canada. bertha.garcia@lhsc.on.ca.
authors.forename: B
authors.initials: B
authors.lastname: Garcia
authors.affiliation: Department of Clinical Neurological Sciences, Western University, London, ON, Canada. tgofton@uwo.ca.|Department of Critical Care Medicine, Western University, London, ON, Canada. tgofton@uwo.ca.|London Health Sciences Centre, University Hospital, Room B2-223, 339 Windermere Road, London, ON, N6A 5A5, Canada. tgofton@uwo.ca.
authors.forename: T E
authors.initials: TE
authors.lastname: Gofton
mesh_terms: D000328:Adult; D015897:Comorbidity; D005260:Female; D006801:Humans; D008297:Male; D065666:Mesenteric Ischemia / Q000453:epidemiology / Q000209:etiology*; D008875:Middle Aged; D013226:Status Epilepticus / Q000453:epidemiology; D055815:Young Adult
keywords: Bowel infarction; Critical care; Non-occlusive mesenteric ischemia; Status epilepticus