Abstract
Non-occlusive mesenteric ischemia (NOMI) is difficult to diagnose in the early phase and often has a poor prognosis. Circulatory failure is a known risk of NOMI. A 74-year-old man with accidental hypothermia complicated by NOMI was admitted to our hospital in an unconscious state. On admission, circulatory failure was observed, and his rectal temperature was 22.7°C and systolic blood pressure was 72 mmHg. Rewarming was performed by warm fluid infusion using a heating system. His temperature increased to approximately 36°C after 4 hours of rewarming along with temporary stabilization of hemodynamic parameters; however, hyperlactatemia and circulatory failure resistant to fluid infusion and inotropic support gradually developed. He developed disseminated intravascular coagulation, and antithrombin and recombinant human soluble thrombomodulin therapy was initiated. Forty-eight hours after admission, abdominal computed tomography findings along with hemorrhagic ascitic fluid collected by paracentesis suggested acute mesenteric ischemia (AMI). Emergency enterocolectomy was performed; however, the patient died 4 days after admission. Histopathological findings included transmural necrosis without blood clotting, which was consistent with the diagnosis of NOMI. Because accidental hypothermia can induce AMI, early diagnosis and management are imperative.
