A strategy for improving the prognosis of non‐occlusive mesenteric ischemia (<scp>NOMI</scp>): a single‐center observational study

Nakamura, Fumiko; Yui, Rintaro; Muratsu, Arisa; Onoe, Atsunori; Nakajima, Mari; Takahashi, Hiroki; Kishimoto, Masanobu; Sakuramoto, Kazuhito; Muroya, Takashi; Kajino, Kentaro; Ikegawa, Hitoshi; Kuwagata, Yasuyuki

doi:10.1002/ams2.422

Cited by 16 publications

(18 citation statements)

References 17 publications

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“…Because our treatment policy is based on a second-look operation, the operative time was short and the amount of bleeding was small; however, the death rate among patients who underwent surgery was relatively higher (61.3%) than that in previous reports. [ 15 , 16 , 20 ] In our study, perioperative factors might not be relevant as prognostic factors, and the SOFA and P-POSSUM scores were high. Nonetheless, given that there is currently no severity classification for NOMI, accurate judgment of treatment outcomes was difficult.…”

Section: Discussionmentioning

confidence: 58%

“…Several large-scale studies on endovascular and surgical treatments for NOMI have emerged [ 13 , 14 ] ; however, the prognostic factors for NOMI remain unclear. Furthermore, reports regarding surgical treatment are contradictory; some recommend a second-look operation, [ 15 , 16 ] whereas 1 study showed that surgery did not significantly improve survival. [ 17 ] Additionally, there is no severity classification for NOMI; thus, treatment cannot be accurately evaluated.…”

Section: Introductionmentioning

confidence: 99%

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Monitoring the Sequential Organ Failure Assessment score in nonocclusive mesenteric ischemia increases the survival rate

et al. 2021

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Several large-scale studies have assessed the endovascular and surgical treatments for nonocclusive mesenteric ischemia (NOMI); nonetheless, the prognostic factors for NOMI remain unclear. In this single-center study, we retrospectively reviewed the electronic medical records of 197, 149 patients were retrieved from the inpatient database of our hospital from January 2011 to January 2020; 79 patients with NOMI were observed. A total of 44 patients who underwent laparotomy were statistically analyzed and divided into the survivor and non-survivor groups. Prognostic factors were compared between the 2 groups. Exploratory laparotomy based on a second-look surgery was the first treatment choice. The overall mortality rate was 61.3%, with a male-to-female ratio of 1.6:1. The median Sequential Organ Failure Assessment (SOFA) score was 11.06 [5.75-17.25]. The median SOFA score was 5 [interquartile range: 3-8] in the survivor group and 14.8 [interquartile range: 10.5-19] in the non-survivor group. The log-rank test showed a significant difference in the presence of diabetes mellitus ( P = .025), hypoglycemia ( P = .001), SOFA score ≥10 ( P < .001), hemoglobin levels ≥11 g/dL ( P = .003), platelet count ≥12.9 × 10 4 /μL ( P = .01), lactate levels ≥2.6 mmol/L ( P = .005), and base excess <-3.0 ( P < .023). Multivariate analysis using the factors with significant differences revealed that SOFA score ≥10 (hazard ratio for death, 1.199; 95% confidence interval, 1.101-1.305; P < .001) was an independent prognostic factor. The SOFA score can be used to assess disease severity. A SOFA score of ≥10 may be associated with increased mortality.

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Section: Discussionmentioning

confidence: 58%

Section: Introductionmentioning

confidence: 99%

Monitoring the Sequential Organ Failure Assessment score in nonocclusive mesenteric ischemia increases the survival rate

et al. 2021

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“…Early detection of bowel ischemia is critical for patient outcomes, and computed tomography is a frequently used modality for diagnosis [ 13 , 14 ]. A study by Nakamura et al found that pneumatosis intestinalis on CT imaging may represent a harbinger of irreversible bowel ischemia necessitating early exploratory laparotomy for definitive diagnosis [ 15 ]. Supportive treatment for NOMI includes intravenous fluid resuscitation, broad-spectrum antibiotic therapy, bowel rest, and close monitoring to assess for worsening clinical status [ 11 , 16 ].…”

Section: Discussionmentioning

confidence: 99%

Methamphetamine-Induced Bowel Ischemia in a 50-Year-Old Male

Kurtz

Alshoubi

Nguyen

et al. 2022

Case Reports in Critical Care

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Methamphetamine intoxication is a known risk factor for nonocclusive mesenteric ischemia (NOMI). We describe a case of a 50-year-old male with a history of polysubstance abuse who presented to the Emergency Department with severe abdominal pain and coffee-ground emesis. Computed tomographic (CT) imaging demonstrated portal venous gas and diffuse colonic wall thickening concerning for ischemic colitis. The patient underwent exploratory laparotomy with resection of the ascending colon as well as a necrotic section of the jejunum. Further embolic workup was negative with a subjective history of amphetamine use prior to presentation. NOMI has a high fatality rate, and we recommend providers include drug-induced bowel infarction on their differential when presented with findings of ischemic bowel of unclear etiology.

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“…Thickness of the bowel wall is the most critical indicator for preservation, although the intestine is not good enough. From the analysis of 30 NOMI patients, Nakamura F found that 33.3% (7/21) of patients requiring additional intestinal resection in the planned second-look operation, because of progressed ischemia or necrosis 24–48 h after the first operation [ 15 ]. We did not reconstruct the alimentary tract immediately, and the preserved intestines were drained separately.…”

Section: Discussionmentioning

confidence: 99%

Nonocclusive mesenteric ischemia caused by type B aortic dissection: a case report

et al. 2022

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Background Nonocclusive mesenteric ischemia (NOMI) is defined as acute intestinal ischemia because of decreased blood flow in mesenteric vessels. Only a few cases of NOMI that occur secondary to aortic dissection (AD) have been reported, resulting in the lack of sufficient knowledge of diagnosis and treatment. Case presentation We aimed to report a case of NOMI caused by type B Aortic Dissection. A 26-year-old male patient was transferred to our hospital with the diagnose of NOMI and aortic dissection in April 2018. The abdominal computed tomography (CT) assists the diagnosis of paralytic intestinal obstruction, intestinal wall pneumatosis, and perforation. Emergency laparotomy revealed that the bowel wall supplied by the superior mesenteric artery (SMA) was pale with the palpable but weak pulsation of the parietal artery. The small intestine was extremely dilated with a paper-thin, fragile wall that was ruptured easily and could not be sutured. In this case, extensive resection and segmental drainage were done. Postoperatively, the digestive tract was reconstructed. However, the patient suffered from iron deficiency anemia and short bowel syndrome eight months later, and unfortunately died from long-term complications. Conclusion Aortic dissection leads to continuous decrease in blood pressure and blood flow to the SMA, considering as a predisposing factor for NOMI. During the treatment, extensive resection and segmental drainage are the optimal surgical strategy, which can make benefit in emergencies especially.

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A strategy for improving the prognosis of non‐occlusive mesenteric ischemia (NOMI): a single‐center observational study

Cited by 16 publications

References 17 publications

Monitoring the Sequential Organ Failure Assessment score in nonocclusive mesenteric ischemia increases the survival rate

Monitoring the Sequential Organ Failure Assessment score in nonocclusive mesenteric ischemia increases the survival rate

Methamphetamine-Induced Bowel Ischemia in a 50-Year-Old Male

Nonocclusive mesenteric ischemia caused by type B aortic dissection: a case report

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