A Case Report of Non-Occlusive Mesenteric Ischemia in a Patient with Multiple Risk Factors

Abstract

Non-occlusive mesenteric ischemia (NOMI) refers to all types of mesenteric ischemia without any organic blockage of blood vessels. It is usually seen in elderly age group with risk factors of previous myocardial infarction, congestive cardiac failure, aortic insufficiency, renal or liver impairment and post-cardiac surgery. Amongst all the cases of acute mesenteric ischemia, NOMI constitutes 20-30%. The mortality is generally high, at least 50% because it usually presents late and the bowel is already gangrenous. Common presentations include nausea, vomiting and acute abdominal pain. Selective angiography is the gold standard to exclude obstructive mesenteric ischemia, for which the diagnosis of NOMI could be made, but one can use other non-invasive modalities such as CT, MRI or ultrasound. Colonoscopy, lactate, arterial blood gas can be used to investigate for bowel ischemia. In the early stages, there is no need for surgery. Surgical intervention is generally limited unless there is a need to excise away the gangrenous bowel. The only effective treatment is by administering intra-arterial vasodilator therapy and it should be done as early as possible to improve prognosis. We describe a case of large bowel ischemia likely secondary to non-occlusive mesenteric ischemia.