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Early recognition is crucial, yet routine monitoring often identifies these signs only after hemodynamic deterioration. A 68-year-old man underwent distal pancreatectomy and splenectomy under combined general and thoracic epidural anesthesia.",{"@graph":69,"@context":122},[70,84,105],{"@type":71,"itemListElement":72},"BreadcrumbList",[73,77,79,82],{"item":74,"name":75,"@type":76,"position":8},"https://docshare.wps.com","Home","ListItem",{"item":78,"name":9,"@type":76,"position":14},"https://docshare.wps.com/document/",{"item":80,"name":35,"@type":76,"position":81},"https://docshare.wps.com/document/healthcare/",3,{"item":83,"name":65,"@type":76,"position":19},"https://docshare.wps.com/document/early-detection-and-management-of-mesenteric-traction-syndrome-using-the-hypotension-prediction-index-a-case-report/455613/",{"url":83,"name":65,"@type":85,"image":86,"author":91,"headline":65,"publisher":94,"fileFormat":97,"inLanguage":63,"description":67,"dateModified":98,"datePublished":99,"encodingFormat":97,"isAccessibleForFree":100,"interactionStatistic":101},"DigitalDocument",{"url":87,"@type":88,"width":89,"height":90},"https://docshare.wps.com/thumbnails/early-detection-and-management-of-mesenteric-traction-syndrome-using-the-hypotension-prediction-index-a-case-report/455613.png","ImageObject",300,407,{"name":92,"@type":93},"Asher","Person",{"url":74,"name":95,"@type":96},"DocShare","Organization","application/pdf","2026-10-07","2026-09-30",true,{"@type":102,"interactionType":103,"userInteractionCount":19},"InteractionCounter",{"@type":104},"ViewAction",{"@type":106,"mainEntity":107},"FAQPage",[108,114,118],{"name":109,"@type":110,"acceptedAnswer":111},"What characterizes mesenteric traction syndrome (MTS) during abdominal surgery?","Question",{"text":112,"@type":113},"MTS presents with sudden hypotension, tachycardia, and facial flushing shortly after mesenteric manipulation.","Answer",{"name":115,"@type":110,"acceptedAnswer":116},"How did the hypotension prediction index (HPI) contribute in this case?",{"text":117,"@type":113},"HPI abruptly increased to >85 despite stable vital signs about 16 minutes after surgery started, indicating early vasodilatory change and allowing intervention before critical hypotension.",{"name":119,"@type":110,"acceptedAnswer":120},"What interventions were used to manage MTS after early detection?",{"text":121,"@type":113},"Prompt intravenous phenylephrine boluses and rapid colloid infusions were given, facial flushing confirmed the diagnosis, and intravenous flurbiprofen stabilized circulation.","https://schema.org",{"og:url":83,"og:type":124,"og:title":65,"og:site_name":95,"og:description":67},"article",{"robots":126,"canonical":83},"index,follow",{"doc_id":128,"site_id":62},455613,1790791227,{"code":4,"msg":5,"data":131},{"doc_id":128,"user_id":132,"nickname":92,"user_avatar":133,"doc_module":4,"category_id":34,"category_name":35,"doc_title":65,"doc_description":67,"doc_content":134,"file_id":135,"file_url":136,"file_type":137,"file_size":138,"view_count":19,"is_deleted":4,"is_public":8,"is_downloadable":8,"audit_status":8,"page_count":19,"language":139,"language_code":63,"site_id":62,"html_lang":63,"table_of_contents":140,"faqs":141,"seo_title":142,"seo_description":67,"update_tm":143,"read_time":52},687197207639,"https://ap-avatar.wpscdn.com/davatar_a8503ba1806abce46bf441b54a3ca4cd","Yajima et al. JA Clinical Reports (2026) 12:3 [https://doi.org/10.1186/s40981-025-00838-0](https://doi.org/10.1186/s40981-025-00838-0)  \nJA Clinical Reports  \nCASE REPORT Open Access  \nEarly detection and management of mesenteric traction syndrome using the hypotension prediction index: a case report  \nRui Yajima 1*, Takayuki Sugai 1, Kei Inoue 1, Takashi Ouchi 1 and Toshiya Koitabashi 1  \nAbstract  \nMesenteric 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. Wereport 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 bol uses 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.  \nKeywords Hypotension prediction index, Mesenteric traction syndrome, Perioperative monitoring, Artificial intelligence, Intraoperative hypotension  \nBackground  \nMesenteric traction syndrome (MTS) is a transient circulatory disturbance that typically presents with hypotension, tachycardia, and facial flushing shortly after mesenteric manipulation during abdominal surgery [1]. It is believed to result from the release of vasodilatory mediators, such as prostacyclin, from the mesentery, leading to a rapid decrease in systemic vascular resistance [2, 3]. In some cases, transient histamine release has also been reported as a contributing factor [4]. Although MTS  \n*Correspondence: Rui Yajima[ryajima@tdc.ac.jp](ryajima@tdc.ac.jp)  \n1Department of Anesthesiology, Tokyo Dental College Ichikawa General Hospital, 5-11-13, Sugano, Ichikawa City, Chiba 272-8513, Japan  \nusually resolves spontaneously, it can occasionally cause profound hypotension that requires prompt treatment.  \nConventional monitoring often detects MTS only after hypotension has already developed, limiting opportunities for preventive intervention. The Hypotension Prediction Index™ (HPI) is a machine learning–based algorithm that analyzes arterial pressure waveforms to predict hypotension several minutes before its clinical onset [5, 6]. The HPI ranges from 0 to 100, with values greater than 85 indicating a high likelihood of hypotension developing within the next few minutes. According to the manufacturer’s recommendation, an HPI value of 85 is defined asthe predictive cutoff for impending hypotension. Randomized trials have demonstrated that HPI-guided management can reduce both the severity and duration of intraoperative hypotension [5]. However, its usefulness  \n© The Author(s) 2025. Open Access This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article’s Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article’s Creative Commons licence and your inten","cbCaivCUCOYvwiDR","https://ap.wps.com/l/cbCaivCUCOYvwiDR","pdf",857616,"English","# Abstract\n# Background\n# Case presentation\n## Figure 1: Hemodynamic changes and therapeutic interventions","[{\"question\":\"What characterizes mesenteric traction syndrome (MTS) during abdominal surgery?\",\"answer\":\"MTS presents with sudden hypotension, tachycardia, and facial flushing shortly after mesenteric manipulation.\"},{\"question\":\"How did the hypotension prediction index (HPI) contribute in this case?\",\"answer\":\"HPI abruptly increased to \\u003e85 despite stable vital signs about 16 minutes after surgery started, indicating early vasodilatory change and allowing intervention before critical hypotension.\"},{\"question\":\"What interventions were used to manage MTS after early detection?\",\"answer\":\"Prompt intravenous phenylephrine boluses and rapid colloid infusions were given, facial flushing confirmed the diagnosis, and intravenous flurbiprofen stabilized circulation.\"}]","Early detection and management of mesenteric traction syndrome using the hypotension prediction index - a case report | PDF",1790743638]