A Case of Non-occlusive Intestinal Ischemia After Surgery for Gangrenous Ischemic Colitis

Abstract

An 83-year-old woman with a day’s history of abdominal pain was found in a dazed state at home by her son and brought by ambulance to our hospital. The patient was in an unstable hemodynamic state and arterial blood gas at arrival revealed marked acidemia. Suspecting ischemic bowel necrosis from the findings of abdominal CT, we performed total colectomy and ileostomy. Postoperatively, the patient’s condition improved, but the hyperlactatemia was persistent, accompanied in time by elevated serum creatinine kinase levels. On day 3, CT showed findings suggestive of non-occlusive mesenteric ischemia. We undertook open abdominal management after partial small bowel resection, and performed jejunostomy on day 5. Although there were difficulties in managing postoperative complications such as intra-abdominal abscess caused by anastomotic leakage of the rectal end and the short bowel syndrome, the patient recovered with conservative treatment and was transferred for rehabilitation on day 140. If gangrenous ischemic colitis is suspected, surgery should be performed bearing in mind the possibility of NOMI, including a second-look operation.