2017 Volume 37 Issue 1 Pages 023-027
A woman in her 90s visited another hospital with a history of abdominal pain and vomiting. Abdominal computed tomography (CT) showed ascites, which was subsequently diagnosed as bloody. She was brought to our hospital because of suspected bowel necrosis. Abdominal CT at our hospital revealed ileus, and we suspected the presence of non-occlusive Mesenteric ischemia (NOMI). Therefore, immediate surgery was performed after intra-arterial injection of papaverine hydrochloride. Intraoperatively, skip small intestinal necroses were observed extensively. We resected two segments of the intestine, but did not perform anastomoses as a damage control strategy. The patient was brought back to the intensive care unit with an open abdomen and was administered a continuous intra-arterial infusion of papaverine hydrochloride. The second-look surgery was performed about 40 hours later to confirm absence of progression of the intestinal necrosis before performing intestinal anastomoses. The postoperative course of the patient was good. Delayed diagnosis of NOMI may be fatal；however, no definite diagnostic criteria for NOMI have been established yet. Therefore, a strong index of suspicion for NOMI should be entertained at the first medical examination. Quick diagnosis and treatment are indispensable life-saving measures.
