A Case of Non-Occlusive Mesenteric Ischemia with a Reoperation for Recurrence

Abstract

Non-occlusive mesenteric ischemia （NOMI） is an acute mesenteric circulatory disease that occurs in the absence of an organic obstruction. The disorder comprises large segmental ischemic lesions in the intestines and recurs in some cases. Management of water and sodium deficiency is often required after surgical intervention. We report herein on a case of NOMI that was treated with resection of the small intestines followed by a reoperation for recurrence. A 72-year-old man presented with abdominal pain and vomiting. After examining him, we strongly suspected intestinal bowel necrosis and performed an emergency laparotomy. The intraoperative findings showed massive necrosis of most of the small intestine. Resection of the necrotic small bowel, jejunostomy and an ileal mucous fistulostomy were performed. On postoperative day 26, the mucous fistula became necrotic. We therefore performed resection of the right colon and a jejunocolic anastomosis. The patient was successfully put on an oral diet with intravenous nutrition. On postoperative day 137, he was transferred to the internal medicine department for management of his nutritional status.