A Case of Non–occlusive Mesenteric Ischemia Developing After Cardiac Surgery That Was Successfully Treated by Segmental Resections and Reconstruction of the Isolated Loop of the Small Bowel

Abstract

A 75–year–old woman with aortic stenosis underwent major cardiac surgery. On day 6 after the surgery, she complained of abdominal pain and her serum lactate level increased. Abdominal CT scan revealed extensive mural pneumatosis of the small bowel and the presence of gas in the portal and superior mesenteric veins. Based on the findings, she was diagnosed as having non–occlusive mesenteric ischemia (NOMI) and emergency laparotomy was performed. Extensive ischemia was observed in a discontinuous manner in the small bowel. Two independent portions of the small bowel that were determined as being necrotic were resected, leaving 180 cm of healthy small bowel between the resected bowel, with jejunostomy on the distal stump. The proximal jejunal and distal ileal stumps were closed and the intestinal contents were drained through an ileus tube and the anus, respectively. The mucosal surface of the remaining small bowel was endoscopically observed on day 10 after the laparotomy, which revealed no further ischemic damage. After the general condition of the patient became stable, small bowel reconstruction was performed on day 21 after the 1st surgery. The postoperative course after the 2nd surgery was uneventful, and the patient was discharged from the hospital on day 49 after the 1st laparotomy. The serum albumin level returned to 3.9 g/dL of, the same level as that recorded prior to the cardiac surgery at 11 months after discharge. This case highlights the importance of preserving portions of the small bowel that do not show ischemic injury, to prevent short bowel syndrome.