Mesenteric Traction Syndrome-Like Symptoms Caused by Lung Traction: A Report of Two Cases

Mesenteric traction syndrome (MTS) is caused by traction of the small intestine and mesentery and is characterized by hot flushes, tachycardia, and low blood pressure. We experienced two cases in which patients exhibited MTS-like symptoms, such as tachycardia, hypotension, and facial flushes, after thoracotomy. After the intravenous administration of flurbiprofen axetil (50 mg), a cyclooxygenase (COX) inhibitor, the patients’ arterial blood pressure recovered, and their facial flushes gradually disappeared. The patients’ postoperative courses were uneventful. It has been reported that the incidence of MTS among patients that undergo surgery for abdominal aortic aneurysms or laparotomic surgery ranges from about 30% to 85%. As MTS has been shown to be caused by the release of prostacyclin (PGI2) due to traction of the small intestine and mesentery, COX inhibitors, such as flurbiprofen axetil, have been recognized as an effective treatment for MTS. The detailed mechanism by which MTS is induced has been demonstrated to involve traction-induced shear stress on the endothelial cells of mesenteric blood vessels activating COX, which consequently increases PGI2 production, leading to vasodilatation throughout the body. Therefore, it seems reasonable that MTS can be caused by both abdominal and thoracic surgery. Recent studies have revealed that MTS has become more common since the introduction of remifentanil. It has been reported that remifentanil itself can induce PGI2 production and cause vasodilation in vitro. Anesthesiologists should be aware that MTS can be induced by thoracic manipulation.