Abstract
Non-occlusive mesenteric ischemia (NOMI) due to hemorrhagic shock caused by trauma is a rare condition. We report herein on a case of necrotic intestinal perforation in a 69-year-old woman following a traffic accident. We performed emergency laparotomy because of hemorrhagic shock due to injury of the right kidney and inferior vena cava, extracted the kidney and restored the inferior vena cava. The patient was in profound shock and manual blockade of the abdominal aorta was conducted to control the bleeding. During this surgery, we confirmed that the intestine and mesenterium were undamaged. We then performed transcatheter arterial embolization for the bleeding of the lumbar vertebrae bone fracture, after which the patient recovered well. On postoperative day 9 we performed a re-operation because the solution in the bowels was flowing out from an abdominal drain. We found intestinal perforation and resected the terminal ileum and ascending colon which was necrotized, and performed anastomosis. Pathologically, evidence was seen of ischemic intestinal necrosis without vascular occlusion. It seemed that the enteric avascular necrosis had been caused by the perioperative profound shock.
