Non-occlusive mesenteric ischemia: two case reports and a short review of the literature

Abstract

NOMI is a rare disease with a difficult diagnosis. Early recognition and treatment with supportive therapy, vasodilator drugs and possibly surgery can significantly lower mortality.

Nonocclusive Mesenteric Ischemia and Interventional Local Vasodilatory Therapy: A Meta-Analysis and Systematic Review of the Literature

“…2 Multiple case reports and small case series described the occurrence of NOMI after cardiac surgery, [3][4][5][6][7][8] heart failure, 4,9 and a variety of heterogeneous acute critical illnesses. [9][10][11][12][13][14][15][16][17][18][19][20][21][22] Risk factors for NOMI appear to be older age as well as cardiovascular and/or chronic kidney disease (CKD) and it occurs especially in situations after major surgery, sepsis, and shock requiring vasopressor therapy. 23,24 Nonocclusive mesenteric ischemia is often only diagnosed in advanced stages of extensive intestinal necrosis, 24 leading to a devastating mortality rate up to 90% that has not changed over the past decades.…”

Diagnosis and Management of Nonocclusive Mesenteric Ischemia

“…Other characteristic findings include reflux of contrast material into the aorta and increased portal venous filling time. 13 Minko et al 14 studied the reproducibility of angiographic criteria in patients with NOMI. Using standard DSA technique, 53 angiographies were performed and analyzed by a radiologist, intensivist, and medical student.…”

“…If the patient remains unstable, a low dose (<0.5 mg/kg/min) norepinephrine is added to maintain the splanchnic circulation by its positive inotropic effect. 13 Additional use of vasopressin may improve survival. 15 Vasodilator therapy includes use of pharmacological agents such as papaverine, nitroglycerine, and glucagon.…”

“…17 Some authors recommend intravenous glucagon (1-10 µg/kg/min) as the treatment of choice if the diagnosis of NOMI is made on MDCT. 13 Glucagon is a pancreatic hormone that increases mesenteric arterial blood flow and reduces vasospasm by relaxing the arterial smooth muscle, by positive inotropic effect, and by increasing the blood glucose concentration. Recently, vascular endothelial Fig.…”

“…Broad-spectrum antibiotic therapy is instituted first for complete coverage, but is changed to specific antibiotics as per the cultures. 13 Surgery is performed to assess the viability of the bowel, to remove infarcted segments of the bowel, and to diagnose and treat any occlusive causes of mesenteric ischemia. The mesenteric arteries and veins are evaluated with intraoperative Doppler sonography in addition to visual inspection and palpation.…”