Abstract
A 69-year-old woman who had undergone hemodialysis for chronic renal failure was admitted to the hospital because of abdominal pain and hypotension. On admission, the abdomen was distended with peritoneal signs in the lower abdomen. An abdominal CT scan showed gas in the hepatic portal vein, but no thrombi in the mesenteric arteries and veins. Nonocclusive mesenteric ischemia (NOMI) was suspected and emergency surgery was performed. The operative findings showed bloody ascites, an unfavorable color of the small intestine and tiny air bubbles in the portal vein. Four meters of necrotic intestine was resected. Histopathological examination of the resected specimen showed no thrombi in the main arteries and veins, and NOMI was diagnosed. As NOMI may occur in hemodialysis patients, a sudden onset of severe abdominal pain should be carefully observed and NOMI was considered as the differential diagnosis.
