Abstract
An 89 year old female with a history of myocardial infarction, chronic heart failure, hypertension, and atrial fibrillation was transferred to our institution with circulatory insufficiency. The patient had been undergone treatment for in-stent restenosis of the middle left ascending artery 1 week back. Her systolic blood pressure was 70 mm Hg with evident cyanosis over the whole body surface. Arterial blood gas analysis revealed severe metabolic acidosis and the patient exhibited severe hypovolemia. Initiation of dopamine therapy and transfusion ameliorated the circulatory failure. Three days after admission, she discharged massive bloody stools without absence of abdominal pain; colonoscopy revealed segmental pattern of mucosa necrosis in the sigmoid colon. Enhanced abdominal computed tomography revealed neither thrombus nor embolus in the mesenteric artery. Blood flow to the sigmoid colon was evident, prompting a diagnosis of non-occlusive mesenteric ischemia. Although emergency surgery was recommended, the patient declined and died of panperitonitis following conservative therapy. In addition to circulatory insufficiency caused by heart failure in this case, the intestinal ischemia also resulted from hypovolemia, diuretics and digitalis therapy, and arteriosclerosis.
Highlights
Acute mesenteric ischemia comprises acute obstructive mesenteric ischemia and acute non-obstructive mesenteric ischemia
We describe the case of a female who developed Non-Occlusive Mesenteric Ischemia (NOMI) during the course of heart failure, thereby suggesting an association between NOMI and circulatory insufficiency, diuretics or digoxin therapy, and atrial fibrillation
Acute mesenteric ischemia is classified as acute occlusive mesenteric ischemia and acute non-occlusive mesenteric ischemia
Summary
Acute mesenteric ischemia comprises acute obstructive mesenteric ischemia and acute non-obstructive mesenteric ischemia. Ischemic colitis is defined as an irreversible mucosal injury induced by intestinal ischemia without organic occlusion of the mesenteric artery. We describe the case of a female who developed NOMI during the course of heart failure, thereby suggesting an association between NOMI and circulatory insufficiency, diuretics or digoxin therapy, and atrial fibrillation. An 89 year old female with a history of myocardial infarction, chronic heart failure, hypertension, and atrial fibrillation was admitted to our hospital with worsening heart failure. She had been taking antiplatelet agent, anticoagulant agent, digitalis, diuretics, and angiotensin receptor blockers. Colonoscopy (Figures 1a and 1b) revealed segmental pattern of mucosal necrosis in the sigmoid colon that was black in colour, suggesting gangrenous ischemic colitis. The main cause of death was panperitonitis resulting from colonic necrosis and perforation
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