Nonocclusive Mesenteric Infarction in Continuous Ambulatory Peritoneal Dialysis

Abstract

Nonocclusive mesenteric infarction has recently been diagnosed with increasing frequency in dialysis patients. Although most reports have concerned patients on hemodialysis, the condition has also been reported to occur in patients on continuous ambulatory peritoneal dialysis. This report describes such a case developing in a woman whose end-stage renal failure was due to adult polycystic kidney disease. Associated predisposing factors were the presence of orthostatic hypoxemia, postural hypotension and extensive atheromatous changes of the abdominal aorta. In keeping with the known difficulty of establishing the diagnosis of mesenteric ischemia, the diagnosis in our patient was also delayed. She was initially thought to suffer from an episode of peritonitis and/or colonic perforation secondary to the performance of a cleansing enema. Only upon showing pneumatosis coli of the right colon on abdominal computerized tomography was the correct diagnosis made. Laparotomy revealed extensive necrosis of the ascending and transverse colon. A total colectomy and ileorectal anastomosis were performed. The patient died on the 17th day following surgery. This case serves to illustrate that mesenteric infarction should be considered in predisposed patients on continuous ambulatory peritoneal dialysis. The presence of peritonitis may mask the underlying pathology and waylay the unwary physician.

Sclerosing encapsulating peritonitis and non‐occlusive mesenteric infarction found at autopsy in a man who had undergone continuous ambulatory peritoneal dialysis: A histochemical and immunohistochemical study

“…Yokota et al 13 reported that all seven SEP patients (3.7%) among 197 CAPD patients exhibited ileus. There have been five cases of NOMI following CAPD and one case following intermittent peritoneal dialysis reported by Korzets et al 14 However, there has never been a reported case of combined SEP and NOMI during or after CAPD. Therefore, the present case is a very rare example and, to the best of our knowledge, is the first to be reported.…”

Non-Occlusive Mesenteric Ischemia in Chronically Dialyzed Patients: A Disease with Multiple Risk Factors

“…In recent years, non-occlusive mesenteric ischemia (NOMI) has become increasingly recognized as a highly dangerous complication in both hemodialysis [1,2,3,4,5,6,7,8,9,10,11,12] and peritoneal dialysis patients, young and old alike [13,14,15]. Undoubtedly, NOMI is seen far more often in hemodialysis patients, with intradialytic hypotension being the major precipitating factor behind the development of NOMI among these patients [1, 2,4,5,6, 11].…”

Ischaemic enteritis in a patient with chronic renal failure: diagnosis and management decisions

“…Embolism or thrombosis of the superior mesenteric artery is the cause of occlusion in the majority of patients 2. Non-occlusive ischaemic enteritis occurs in 25% of all patients with ischaemic enteritis, and this entity usually manifests in the setting of haemodynamic decompensation superimposed on a severely stenosed mesenteric vasculature 2 3…”

“…Diabetes, hypertension and ischaemic heart disease are common predisposing factors both for renal failure and ischaemic enteritis 1. Other risk factors include wide-spread atherosclerosis, smoking, advanced age, hyperlipidaemia, secondary hyperparathyroidism, use of digoxin (a drug with potential vasoconstrictive effects on mesenteric vessels), bleeding diatheses and mechanical problems such as volvulus and an incarcerated hernia 3 6 9. In addition, vasculitis, fibromuscular dysplasia and arterial dissection may also present with ischaemic enteritis 2 10.…”

“…An aggressive ultrafiltration protocol and increased time on haemodialysis can cause a hypotensive episode during haemodialysis. This hypotension, especially when recurrent, is a significant risk factor for non-occlusive mesenteric ischaemia in patients on dialysis 3 6…”