Case Of Nonocclusive Mesenteric Ischemia Research Articles

Non-occlusive mesenteric ischemia during acute stroke management: three case reports

BackgroundThere are many reports of non-occlusive mesenteric ischemia in patients on maintenance hemodialysis and following cardiac surgery. However, there are few reports of non-occlusive mesenteric ischemia in patients with acute stroke.Case presentationWe report three cases of non-occlusive mesenteric ischemia with onset during treatment for acute stroke. All of the patients were undergoing strict blood-pressure control, and two patients developed NOMI soon after tracheostomy when enteral nutrition had been resumed.ConclusionMany stroke patients are older adults with risk factors such as arteriosclerosis. Thus, during acute stroke management, there is a possibility that patients may develop non-occlusive mesenteric ischemia due to decreased intestinal blood flow secondary to strict blood-pressure control. This case report implicates early enteral nutrition as a potential etiopathogenic factor of non-occlusive mesenteric ischemia in patients with acute stroke.

A Case of Non-occlusive Mesenteric Ischemia with Duodenal Necrosis

症例は67歳，女性．慢性腎不全に対し維持透析中であったが，吐血・意識障害を認め救急搬送された．代謝性アシドーシスを伴う非閉塞性腸管虚血症（NOMI）と診断し，緊急手術を行った．小腸はほぼ全長に渡り虚血に陥っており，まずopen abdomen管理とした．翌日，second lookで小腸に加え十二指腸・上行結腸・横行結腸も壊死が及んでおり，十二指腸～空腸・空腸・回腸～上行結腸・横行結腸の4箇所を切除し外瘻化した．術後2日目に抜管したが，膵液漏出が著しく14日目に再々手術を施行した．十二指腸の壊死が進行しており，Tチューブを挿入し胃壁と腹壁を縫合し，完全外瘻化した．完全静脈栄養管理で，術後91日目に維持透析のため転院となったが，全身状態が悪化し術後141日目に死亡した．NOMIは小腸に非連続に虚血を呈する疾患であるが，壊死が十二指腸まで及ぶ報告は稀で予後も不良である．広範囲壊死腸管切除と残存腸管の完全外瘻化により在院死を回避しえた重症NOMIの1例を経験したので報告する．

A Case of Non-Occlusive Mesenteric Ischemia Immediately after Open Heart Surgery

A Case of Non-Occlusive Mesenteric Ischemia Immediately after Open Heart Surgery

Enteral Nutrition With High-Dose Vasopressors.

Enteral Nutrition With High-Dose Vasopressors.

計画的二期手術にて救命し得た，高浸透圧高血糖症候群を契機に発症した非閉塞性腸管虚血症の1例(Succesful treatment of non–occlusive mesenteric ischemia induced by hyperosmolar hyperglycemic state, requiring planned two–stage surgery: a case report)

要旨症例は67歳の男性で，喉頭癌（cT3N1M0 stage III）に対し喉頭亜全摘術および気管切開術を施行された。術後の経管栄養開始後に血糖上昇傾向となり，その後，高浸透圧高血糖症候群（hyperosmolar hyperglycemic syndrome: HHS）を発症した。さらに浸透圧利尿による脱水にて腸管低灌流を合併したことによると思われる非閉塞性腸管虚血症（non–occlusive mesenteric ischemia: NOMI）が疑われたため，緊急で診断的腹腔鏡検査を施行した。その結果，明らかに壊死した腸管を認めたため開腹手術に移行し，初回手術では壊死腸管の切除のみを行った。集中治療後に二期的に腸管再建術を施行し，その際にインドシアニングリーン蛍光法にて残存腸管に血流障害がないことを確認した。今回我々は，HHSを契機に発症したと考えられるNOMIの1例を経験した。NOMIは非常に致死率の高い予後不良な疾患であるが，計画的な二期手術および集中治療にて救命し得た。自験例について，文献的考察を交えて報告する。

A Case of Non-occlusive Mesenteric Ischemia (NOMI) Caused by Overdoses of Antihypertensive Drugs

A Case of Non-occlusive Mesenteric Ischemia (NOMI) Caused by Overdoses of Antihypertensive Drugs

Nonocclusive mesenteric ischemia associated with postoperative jejunal tube feeding: Indicators for clinical management.

Postoperative nutrition via a jejunal tube after major abdominal surgery is usually well tolerated. However, some patients develop nonocclusive mesenteric ischemia (NOMI). This morbid complication has a grave prognosis with a mortality rate of 41% to 100%. Early symptoms are nonspecific, and no treatment guideline is available. We reviewed cases of NOMI at our institution and cases described in the literature to identify factors that impact the clinical course. Among five patients, three had no necrosis and one had segmental necrosis and perforation. These patients recovered with limited resection and decompression of the bowel and abdominal compartment. In one patient with extended bowel necrosis at the time of re-laparotomy, NOMI progressed and the patient died of multiple organ failure. The extent of small bowel necrosis at the time of re-laparotomy is a relevant prognostic factor. Therefore, early diagnosis and treatment of NOMI can improve the prognosis. Clinical symptoms of abdominal distension, cramps and high reflux plus paraclinical signs of leukocytosis, hypotension and computed tomography findings of a distended small bowel with pneumatosis intestinalis and portal venous gas can help to establish the diagnosis. We herein introduce an algorithm for the diagnosis and management of NOMI associated with jejunal tube feeding.

Three cases of non-occlusive mesenteric ischemia that developed after head and neck cancer therapy

Non-occlusive mesenteric ischemia (NOMI) causes intestinal necrosis due to irreversible ischemia of the intestinal tract despite the absence of organic obstruction in the mesenteric blood vessels. The disease has extremely poor prognosis. We report three cases of NOMI hypothesized to have developed after head and neck cancer therapy; thus, we report these cases considering the available literature. Case 1: A 74-year-old man with T2N0M0 stage Ⅱ oropharyngeal carcinoma complained of abdominal pain 5 days after chemoradiotherapy. The patient was diagnosed with NOMI, and an emergency surgery was performed. Case 2: A 69-year-old man with T2N2bM0 stage IVA hypopharyngeal carcinoma complained of abdominal pain during TPF chemotherapy. The patient was diagnosed with NOMI, and he died on the same day. Case 3: A 82-year-old man with T2N2bM0 stage IVA hypopharyngeal carcinoma complained of abdominal pain with reduced level of consciousness, 5 days after total laryngopharyngectomy. The patient was diagnosed with NOMI, and an emergency surgery was performed on the same day. We therefore suggest that ENT physicians must be aware of NOMI as a complication that can develop after head and neck cancer therapy.

Two Cases of Non-occlusive Mesenteric Ischemia after Chemotherapy for Head and Neck Cancer

Two Cases of Non-occlusive Mesenteric Ischemia after Chemotherapy for Head and Neck Cancer

A Case of Non-occlusive Mesenteric Ischemia Preceded by Ischemic Colitis in the Transverse Colon

A Case of Non-occlusive Mesenteric Ischemia Preceded by Ischemic Colitis in the Transverse Colon

Evaluation of the Preoperative Sofa Score as a Postoperative Prognostic Factor in Emergency Cases of Nonocclusive Mesenteric Ischemia

Evaluation of the Preoperative Sofa Score as a Postoperative Prognostic Factor in Emergency Cases of Nonocclusive Mesenteric Ischemia

A Case of Non-Occlusive Mesenteric Ischemia with a Reoperation for Recurrence

A Case of Non-Occlusive Mesenteric Ischemia with a Reoperation for Recurrence

A Case of Non-Occlusive Mesenteric Ischemia During Postoperative Early Enteral Nutrition

A Case of Non-Occlusive Mesenteric Ischemia During Postoperative Early Enteral Nutrition

A Case of Nonocclusive Mesenteric Ischemia Treated by Continuous Intravenous Administration of Prostaglandin E<sub>1</sub>

A Case of Nonocclusive Mesenteric Ischemia Treated by Continuous Intravenous Administration of Prostaglandin E<sub>1</sub>

An investigation of bedside laparoscopy in the ICU for cases of non-occlusive mesenteric ischemia

BackgroundAcute mesenteric ischemia is a rare affection with high related mortality. NOMI presents the most important diagnostic problems and is related with the higher risk of white laparotomy. This study wants to give a contribution for the validation of laparoscopic approach in case of NOMI.MethodsThirty-two consecutive patients were admitted in last 10 years in ICU of Paolo Giaccone University Hospital of Palermo for AMI. Diagnosis was obtained by multislice CT and selective angiography was done if clinical conditions were permissive. If necrosis was already present or suspected, surgical approach was done. Endovascular or surgical embolectomy was performed when necessary. Twenty NOMI patients underwent medical treatment performing laparoscopy 24 h later to verify the evolution of AMI. A three-port technique was used. In all patients we performed a bed side procedure 48–72 h later in both non-resected and resected group.ResultsIn 14 up 20 case of NOMI the disease was extended throughout the splanchnic district, in 6 patients it involved the ileum and the colon; after a first look, only 6 patients underwent resection. One patient died 35 h after diagnosis of NOMI. The second look, 48 h later, demonstrated 4 infarction recurrences in the group of resected patients and onset signs of necrosis in 5 patients of non-resected group. A total of 15 resections were performed on 11 patients. Mortality rate was 6/20–30% but it was much higher in resected group (5/11–45,5%). Non-therapeutic laparotomy was avoided in 9/20 patients and in this group mortality rate was 1/9–11%. No morbidity was recorded related to laparoscopic procedure.ConclusionsLaparoscopy could be a feasible and safety surgical approach for management of patient with NOMI. Our retrospective study demonstrates that laparoscopy don’t increase morbidity, reduce mortality avoiding non-therapeutic laparotomy.

消化管アミロイドーシスに非閉塞性腸管虚血を併発した1例

消化管アミロイドーシスに非閉塞性腸管虚血を併発した1例

非閉塞性腸管虚血症を伴った食道裂孔ヘルニア嵌頓の1例

非閉塞性腸管虚血症を伴った食道裂孔ヘルニア嵌頓の1例

S状結腸虚血性腸炎に続発した右側結腸非閉塞性腸管虚血症の1例

S状結腸虚血性腸炎に続発した右側結腸非閉塞性腸管虚血症の1例

絞扼性イレウスに併発した非閉塞性腸間膜虚血症の1例

絞扼性イレウスに併発した非閉塞性腸間膜虚血症の1例

A Case of Non-Occlusive Mesenteric Ischemia with Hepatic Portal Venous Gas Successfully Treated by Continuous Intra-Arterial Infusion Therapy

A Case of Non-Occlusive Mesenteric Ischemia with Hepatic Portal Venous Gas Successfully Treated by Continuous Intra-Arterial Infusion Therapy