Non-Occlusive Mesenteric Ischemia Due to Hirudotherapy: A Case Report
Akalın Ç, Ekmen N (2020) · Cureus · n=1
RCT evidence detailTrial reference
GRADE Very LowInsufficient evidenceCondition: Diabetic Peripheral Neuropathy (Investigational Adjunct) →
Study Profile
- Design
- single-patient case report (57-year-old male, Ordu University Training and Research Hospital, Turkey)
- Sample size (n)
- 1
- Intervention
- Hirudotherapy applied to diabetic foot wounds with subsequent prolonged uncontrollable bleeding and non-occlusive mesenteric ischemia
- Comparator
- Conventional diabetic foot wound care
- Primary endpoint
- Identification of severe hirudotherapy adverse event - non-occlusive mesenteric ischemia
- Primary result
- Excessive bleeding from leech bites caused hypovolemia and non-occlusive mesenteric ischemia; CT showed hepatic portal venous gas and pneumatosis intestinalis; laparotomy revealed necrosis of terminal ileum and entire colon; necrotic segments resected with end-ileostomy; patient discharged day 17
- Follow-up duration
- 17 days hospitalization with surgical resection
- PMID
- 32874797
Key Findings
- Non-occlusive mesenteric ischemia from hirudotherapy bleeding
- Hypovolemia-driven splanchnic hypoperfusion
- Necrosis of terminal ileum and entire colon required resection
- End-ileostomy permanent at discharge
- Critical safety signal for unsupervised hirudotherapy
Limitations
- Single case - cannot quantify incidence
- Diabetic foot wound treatment context may amplify risk
- Unable to establish causal link with full certainty
- Cannot recommend protocol changes from single case
- Patient demographics specific to Turkish clinical context
Clinical Implications
Akalın 2020 documents a catastrophic outcome (ischemic bowel necrosis requiring colectomy) from prolonged bleeding after off-label hirudotherapy for diabetic foot wounds. For US clinicians under K040187, this case reinforces the device's restricted indication (postoperative venous congestion in supervised settings) and the dangers of unsupervised use. Critical patient safety education content.