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

## TL;DR

A case report shows how an AI-based system detected early signs of a rare surgical complication before severe symptoms occurred.

## Contribution

Demonstrates the use of hypotension prediction index for early detection of mesenteric traction syndrome during surgery.

## Key findings

- The hypotension prediction index detected early vasodilatory changes before visible symptoms of MTS occurred.
- Timely intervention with phenylephrine and colloid infusions prevented severe hypotension in the patient.
- Facial flushing confirmed the diagnosis, and flurbiprofen helped stabilize circulation.

## Abstract

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.