Jejunal Necrosis due to Comorbid Amyloidosis and Nonocclusive Mesenteric Ischemia following Cardiac Cancer Surgery—A Case Report—

SHIBASAKI Masayuki, MASUDA Kouichi, IJICHI Masayoshi, KUBOTA Keisuke, KUSAKA Kouji, MIURA Hideaki, ABE Keiko

doi:10.3919/jjsa.81.493

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Other Title

噴門部癌術後のアミロイドーシスとNOMIの合併による空腸壊死の1例
症例噴門部癌術後のアミロイドーシスとNOMIの合併による空腸壊死の1例
ショウレイフンモンブガンジュツゴノアミロイドーシスト NOMI ノガッペイニヨルクウチョウエシノ 1レイ

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Abstract

<p>The case of an 80-year-old man who required emergency surgery for jejunal necrosis caused by amyloidosis and nonocclusive mesenteric ischemia (NOMI) 6 days after cardiac cancer surgery is presented. In the second operation, the jejunum showed discontinuous patches of dark purple discoloration ; since the extent of resection could not be determined from the macroscopic findings alone, indocyanine green (ICG) fluorescence was used to assess intestinal viability, and an 85-cm portion of the jejunum was resected. The inner lumen of the resected specimen was stenotic due to amyloid deposition in the jejunal submucosal vessels, and this was attributed to comorbid amyloidosis and NOMI. Caution is required when treating NOMI because the extent of intestinal necrosis is frequently unclear, and unless appropriate resection is performed, there is a risk that extended bowel resection may lead to short bowel syndrome or postoperative necrosis of the remaining bowel. ICG fluorescence was useful for assessing the viability of slightly discolored bowel, but since it is not a quantitative method of evaluation, further investigations are required for the accurate diagnosis of ischemic bowel.</p>

Journal

Nihon Rinsho Geka Gakkai Zasshi (Journal of Japan Surgical Association)

Nihon Rinsho Geka Gakkai Zasshi (Journal of Japan Surgical Association) 81 (3), 493-499, 2020

Japan Surgical Association

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