# Clinical Case Report: Neonatal Mesenteric Traction Syndrome During Surgery for Congenital Duodenal Stenosis

## TL;DR

A two-day-old girl developed mesenteric traction syndrome during surgery for a duodenal issue, showing symptoms like low blood pressure and flushing, which were successfully treated.

## Contribution

This is the first documented case of mesenteric traction syndrome in a neonate during abdominal surgery.

## Key findings

- The neonate exhibited classic MTS symptoms including hypotension, tachycardia, and flushing during bowel manipulation.
- Treatment with phenylephrine and infusion loading restored hemodynamic stability within 10 minutes.
- The syndrome occurred specifically after bowel manipulation and resolved without long-term complications.

## Abstract

Mesenteric traction syndrome (MTS) is a common complication of major abdominal surgery, characterized by flushing, hypotension, and tachycardia. However, its occurrence in neonates has not yet been documented. This report details a neonatal case of MTS that emerged during surgery for congenital duodenal stenosis. The patient was a two-day-old girl, born at 39 weeks and three days of gestation via vaginal delivery, weighing 2708 g. She underwent general anesthesia for the surgery, and continuous IV administration of remifentanil at 0.2 μg/kg/min was commenced minutes before the surgery began. Initially, her arterial pressure was 60-70/40-50 mmHg. However, shortly after bowel manipulation began, her blood pressure rapidly declined to 31/25 mmHg. Concurrently, her heart rate increased from 120 to 170 beats per minute, and she displayed facial and upper body flushing. Arterial blood gas analysis indicated a PaO2 drop from 124 to 61 mmHg at an FiO2 of 0.3. Treatment consisted of infusion loading and two bolus doses of 2.5 μg of phenylephrine (diluted to 2.5 μg/mL), which normalized her blood pressure within approximately 10 minutes. The facial flushing gradually subsided and disappeared after 40 minutes. Subsequent circulatory stability allowed for the successful completion of the surgery. There was no alteration in airway pressure, and hemodynamic stability was only compromised following the commencement of bowel manipulation. Given the serious risks associated with prolonged hemodynamic instability in neonates, the potential for MTS should be considered during anesthetic management in such cases.