Non-occlusive Mesenteric Ischemia of the Antethoracic Jejunum after Esophageal Reconstruction following Subtotal Esophagectomy

Abstract

DepartmentsofSurgery 1) andRadiology 2) ,JapaneseRedCrossNagoyaDaiichiHospital A65-year-oldmandiagnosedwithadenocarcinomaoftheesophagogastricjunctionunderwentsubtotal esophagectomy, total gastrectomy, antethoracic reconstruction using the pedunculated jejunum, jejunum using supercharge and drainage techniques. On the 7th postoperative day (POD), he developed pneumonia.Onthe8thPOD,theantethoracicjejunaltissuewasdistendedandbloodtestsshowedelevatedinflammatorybiomarkers. Contrast-enhancedCTscanrevealedaswollenantethoracicjejunumwithlesscontrastenhancement andamistymesentery.Gastrointestinalendoscopyrevealedanedematous,erythematousjejunalmucosa withmultipleerosions. Three-dimensionalCTangiographyrevealedapatentantethoracicjejunalartery,indicatingischemic jejunitisduetonon-occlusivemesentericischemia(NOMI)withcontractionoftheatraitarteryofthejejunum,whichmightbecausedbypneumonia.Becausetherewasnoevidenceofnecrosisoftheantethoracicjejunum,thepatientwasconservativelytreatedforpneumoniaandhypovolemia.Onthe13thPOD, NOMIresolved.AlthoughNOMIofthereconstructedorgancanoccasionallydevelopafteresophagectomy,conservativetherapymaybeeffectiveinselectedpatientsinwhomNOMIisdiagnosedearly.