2012 Volume 32 Issue 7 Pages 1239-1242
Non-occlusive mesenteric ischemia (NOMI) is a condition in which an ischemic lesion occurs in the digestive tract in the absence of organic blockage in a major artery, and is typically associated with a poor prognosis. We report herein on the case of a 76-year-old female patient who was examined at the emergency center with abdominal pain as the main complaint. An abdominal CT scan revealed free gas and ascites, but no blockage in the superior mesenteric artery. The patient was diagnosed as having diffuse peritonitis caused by gastrointestinal perforation and was admitted to surgery for an emergency abdominal operation. During the operation it was found that a large volume of excreta had leaked out intra-abdominally, and perforation was found in the sigmoid colon. A macular, discontinuous, black discoloration presented in the sigmoid colon, uterus and serous membrane of the urinary bladder, suggesting ischemia; a similar finding of continuous ischemia was made for the serous membrane in the whole area of the small intestine, approximately 30cm from the end of the ileum. The pathological finding revealed perforation in the diverticulum of the sigmoid colon, while the small intestine presented with hemorrhage in the serous membrane, blood congestion in the submucosa, and necrosis. These findings led to a diagnosis of NOMI.
