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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)\u2014an artificial intelligence\u2013based monitoring system\u2014abruptly increased to\u2009&gt;\u200985 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.<\/jats:p>","DOI":"10.1186\/s40981-025-00838-0","type":"journal-article","created":{"date-parts":[[2025,12,2]],"date-time":"2025-12-02T05:48:17Z","timestamp":1764654497000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Early detection and management of mesenteric traction syndrome using the hypotension prediction index: a case report"],"prefix":"10.1186","volume":"12","author":[{"ORCID":"https:\/\/orcid.org\/0009-0003-1282-8577","authenticated-orcid":false,"given":"Rui","family":"Yajima","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Takayuki","family":"Sugai","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Kei","family":"Inoue","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Takashi","family":"Ouchi","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Toshiya","family":"Koitabashi","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"297","published-online":{"date-parts":[[2025,12,2]]},"reference":[{"key":"838_CR1","doi-asserted-by":"publisher","DOI":"10.1016\/j.accpm.2022.101162","volume":"42","author":"AA Olsen","year":"2023","unstructured":"Olsen AA, Bazancir LA, Dahl S, Fukumori D, Shiwaku H, Svendsen LB, et al. Mesenteric traction syndrome \u2013 incidence, impact, and treatment: a systematic scoping review of the literature. Anaesth Crit Care Pain Med. 2023;42:101162. https:\/\/doi.org\/10.1016\/j.accpm.2022.101162.","journal-title":"Anaesth Crit Care Pain Med"},{"key":"838_CR2","doi-asserted-by":"publisher","first-page":"669","DOI":"10.1007\/s00540-010-0998-y","volume":"24","author":"Y Nomura","year":"2010","unstructured":"Nomura Y, Matsubara C, Taguchi M, Nishiwaki K. Remifentanil increases the incidence of mesenteric traction syndrome during general anesthesia for elective open abdominal surgery: a randomized controlled trial. J Anesth. 2010;24:669\u201374. https:\/\/doi.org\/10.1007\/s00540-010-0998-y.","journal-title":"J Anesth"},{"key":"838_CR3","doi-asserted-by":"publisher","first-page":"296","DOI":"10.1016\/j.ejphar.2006.03.009","volume":"536","author":"M Bucher","year":"2006","unstructured":"Bucher M, Kees FK, Messmann B, Lunz D, Rath S, Zelenka M, et al. Prostaglandin I2 release following mesenteric traction during abdominal surgery is mediated by cyclooxygenase-1. Eur J Pharmacol. 2006;536:296\u2013300. https:\/\/doi.org\/10.1016\/j.ejphar.2006.03.009.","journal-title":"Eur J Pharmacol"},{"key":"838_CR4","doi-asserted-by":"publisher","first-page":"495","DOI":"10.1007\/pl00012418","volume":"51","author":"D Duda","year":"2002","unstructured":"Duda D, Kaemmerer D, Wirth S, Bode C, Hohenberger W, Brueckl WM, et al. Histamine release in mesenteric traction syndrome during abdominal aortic aneurysm surgery: prophylaxis with H1 and H2 antihistamines. Inflamm Res. 2002;51:495\u20139. https:\/\/doi.org\/10.1007\/pl00012418.","journal-title":"Inflamm Res"},{"key":"838_CR5","doi-asserted-by":"publisher","first-page":"1052","DOI":"10.1001\/jama.2020.0592","volume":"323","author":"M Wijnberge","year":"2020","unstructured":"Wijnberge M, Geerts BF, Hol L, van Berge Henegouwen MI, Hollmann MW, Vlaar APJ, et al. Effect of a machine learning\u2013derived early warning system for intraoperative hypotension vs standard care on depth and duration of intraoperative hypotension during elective noncardiac surgery: the HYPE randomized clinical trial. JAMA. 2020;323:1052\u201360. https:\/\/doi.org\/10.1001\/jama.2020.0592.","journal-title":"JAMA"},{"key":"838_CR6","doi-asserted-by":"publisher","first-page":"681","DOI":"10.1016\/j.bja.2021.05.033","volume":"127","author":"J Schenk","year":"2021","unstructured":"Schenk J, Wijnberge M, Maaskant JM, Hollmann MW, Hol L, Immink RV, et al. Effect of hypotension prediction index-guided intraoperative haemodynamic care on depth and duration of postoperative hypotension: a sub-study of the Hypotension Prediction trial. Br J Anaesth. 2021;127:681\u20138. https:\/\/doi.org\/10.1016\/j.bja.2021.05.033.","journal-title":"Br J Anaesth"},{"key":"838_CR7","doi-asserted-by":"publisher","first-page":"1217","DOI":"10.1097\/ALN.0b013e3181c14930","volume":"111","author":"JB Bijker","year":"2009","unstructured":"Bijker JB, van Klei WA, Kappen TH, van Wolfswinkel L, Moons KG, Kalkman CJ. Incidence of intraoperative hypotension as a function of the chosen definition: literature definitions applied to a retrospective cohort using automated data collection. Anesthesiology. 2009;111:1217\u201326. https:\/\/doi.org\/10.1097\/ALN.0b013e3181c14930.","journal-title":"Anesthesiology"},{"key":"838_CR8","doi-asserted-by":"publisher","first-page":"563","DOI":"10.1016\/j.bja.2019.01.013","volume":"122","author":"DI Sessler","year":"2019","unstructured":"Sessler DI, Bloomstone JA, Aronson S, Berry C, Gan TJ, Kellum JA, et al. Perioperative quality initiative consensus statement on intraoperative blood pressure, risk and outcomes for elective surgery. Br J Anaesth. 2019;122:563\u201374. https:\/\/doi.org\/10.1016\/j.bja.2019.01.013.","journal-title":"Br J Anaesth"},{"key":"838_CR9","doi-asserted-by":"publisher","first-page":"507","DOI":"10.1097\/ALN.0b013e3182a10e26","volume":"119","author":"M Walsh","year":"2013","unstructured":"Walsh M, Devereaux PJ, Garg AX, Kurz A, Turan A, Rodseth RN, et al. Relationship between intraoperative mean arterial pressure and clinical outcomes after noncardiac surgery: toward an empirical definition of hypotension. Anesthesiology. 2013;119:507\u201315. https:\/\/doi.org\/10.1097\/ALN.0b013e3182a10e26.","journal-title":"Anesthesiology"},{"key":"838_CR10","doi-asserted-by":"publisher","first-page":"515","DOI":"10.1097\/ALN.0000000000000765","volume":"123","author":"LY Sun","year":"2015","unstructured":"Sun LY, Wijeysundera DN, Tait GA, Beattie WS. Association of intraoperative hypotension with acute kidney injury after elective noncardiac surgery. Anesthesiology. 2015;123:515\u201323. https:\/\/doi.org\/10.1097\/ALN.0000000000000765.","journal-title":"Anesthesiology"},{"key":"838_CR11","doi-asserted-by":"publisher","first-page":"47","DOI":"10.1097\/ALN.0000000000001432","volume":"126","author":"V Salmasi","year":"2017","unstructured":"Salmasi V, Maheshwari K, Yang D, Mascha EJ, Singh A, Sessler DI, et al. Relationship between intraoperative hypotension, defined by either reduction from baseline or absolute thresholds, and acute kidney and myocardial injury after noncardiac surgery: a retrospective cohort analysis. 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Anesth Analg. 2021;132:1654\u201363. https:\/\/doi.org\/10.1213\/ANE.0000000000005250.","journal-title":"Anesth Analg"}],"container-title":["JA Clinical Reports"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1186\/s40981-025-00838-0.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/article\/10.1186\/s40981-025-00838-0","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1186\/s40981-025-00838-0.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,1,6]],"date-time":"2026-01-06T14:57:45Z","timestamp":1767711465000},"score":1,"resource":{"primary":{"URL":"https:\/\/link.springer.com\/10.1186\/s40981-025-00838-0"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,12,2]]},"references-count":13,"journal-issue":{"issue":"1","published-online":{"date-parts":[[2026,12]]}},"alternative-id":["838"],"URL":"https:\/\/doi.org\/10.1186\/s40981-025-00838-0","relation":{},"ISSN":["2363-9024"],"issn-type":[{"type":"electronic","value":"2363-9024"}],"subject":[],"published":{"date-parts":[[2025,12,2]]},"assertion":[{"value":"14 October 2025","order":1,"name":"received","label":"Received","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"21 November 2025","order":2,"name":"revised","label":"Revised","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"25 November 2025","order":3,"name":"accepted","label":"Accepted","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"2 December 2025","order":4,"name":"first_online","label":"First Online","group":{"name":"ArticleHistory","label":"Article History"}},{"order":1,"name":"Ethics","group":{"name":"EthicsHeading","label":"Declarations"}},{"value":"In accordance with our institutional policy, this single-patient case report did not require approval by the Institutional Review Board (IRB). Written informed consent for publication was obtained from the patient.","order":2,"name":"Ethics","group":{"name":"EthicsHeading","label":"Ethics approval and consent to participate"}},{"value":"Written informed consent for publication of this case report and accompanying images was obtained from the patient. According to our institutional policy, IRB approval was not required for this single case report.","order":3,"name":"Ethics","group":{"name":"EthicsHeading","label":"Consent for publication"}},{"value":"For clinical evaluation, a HemoSphere Advanced Monitoring Platform was temporarily provided on a trial basis by Becton Dickinson and Company (Irvine, CA, USA). The Acumen IQ sensor used in this procedure was purchased from our institution. The authors declare no conflict of interest related to this study.","order":4,"name":"Ethics","group":{"name":"EthicsHeading","label":"Competing interests"}}],"article-number":"3"}}