Abstract
Nonocclusive mesenteric ischemia (NOMI), caused by low cardiac output and hypovolemia, has a poor prognosis. We report a case of NOMI secondary to hemorrhagic shock due to trauma. A 71-year-old man, injured by a mudslide during water main maintenance, was transported to our hospital. On arrival, he was in a state of hemorrhagic shock but his blood pressure raised by fluid resuscitation. We diagnosed an unstable pelvic fracture, hemoretroperitoneum, intra-abdominal bladder injury, and urethral injury by computed tomography. We performed emergency laparotomy, cystostomy, repair of the injured bladder, gauze packing of the retroperitoneum, and vacuum-packing closure (VPC). On day 3 of hospitalization, we removed the pack and noticed an ischemic change in the ileum. It was unclear whether the ischemia was reversible, and VPC was needed for the remaining hemoretroperitoneum. Observation of the ischemic intestine over the plastic bag of the VPC revealed advancement of ischemia. A third operation was performed on day 5 of hopitalization. Given that the ileum showed discontinuous necrosis, we performed a resection of the partial ileum and cecum, and reconstructed them by functional end-to-end anastomosis. An early diagnosis was possible by observing the ischemic intestine over the plastic bag used in VPC.
