A case of nonocclusive mesenteric ischemia that could not be diagnosed despite diagnostic laparotomy

DOI 6 Citations 9 References
  • Sawada Takeshi
    Division of Traumatology and Critical Care Medicine, Sapporo Medical University School of Medicine
  • Kuroda Hiromitsu
    Division of Traumatology and Critical Care Medicine, Sapporo Medical University School of Medicine
  • Masuda Yoshiki
    Division of Traumatology and Critical Care Medicine, Sapporo Medical University School of Medicine
  • Imaizumi Hitoshi
    Division of Traumatology and Critical Care Medicine, Sapporo Medical University School of Medicine
  • Tatsumi Hiroomi
    Division of Traumatology and Critical Care Medicine, Sapporo Medical University School of Medicine
  • Obama Takuro
    Division of Traumatology and Critical Care Medicine, Sapporo Medical University School of Medicine
  • Hata Fumitake
    First Department of Surgery, Sapporo Medical University School of Medicine
  • Asai Yasufumi
    Division of Traumatology and Critical Care Medicine, Sapporo Medical University School of Medicine

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Other Title
  • 試験開腹でも早期診断できなかった非閉塞性腸管虚血症の一例

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We report a case of nonocclusive mesenteric ischemia (NOMI) that could not be diagnosed despite diagnostic laparotomy. A 76-year-old man underwent urgent sigmoidectomy because of panperitonitis caused by perforated sigmoid diverticulitis. On the 2nd ICU day, shock occurred and serum lactate level increased. Necrosis of the intestine was suspected, and a second diagnostic laparotomy was performed. Significant findings of mesenteric ischemic changes were not obtained during laparotomy, but the increase in serum lactate level persisted. On the 4th ICU day, an abdominal enhanced CT scan showed a poorly contrasted intestine but no occlusive thrombus in the superior mesenteric artery and vein or in the portal vein. On the 5th ICU day, the abdominal sutured wound spontaneously unfastened, revealing necrosis of the whole intestine. Despite supportive therapy except for resection of the necrotic intestine, the patient died on the 9th ICU day. The pathogenesis of NOMI is thought to be vasospasm of peripheral mesenteric arteries. Therefore, in cases of acute mesenteric ischemia, a diagnosis of NOMI is difficult even if direct observation of intestine by diagnostic laparotomy is carried out in the early phase. Open abdominal observation using sterilized transparent drape may be a useful option for management of suspected NOMI when diagnostic laparotomy has failed.

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