Abstract
An 82-year-old man was transported to our emergency room with hematemesis, melena, and dyspnea. He became hemodynamically unstable during the examination. The blood test revealed increased inflammatory response and endotoxin positivity. We diagnosed septic shock and he was admitted. After hospitalization, he had signs of peritonitis and we performed emergency laparotomy. Operative findings revealed that there were segmental necrosis of the jejunum and duodenum. We diagnosed non-occlusive mesenteric ischemia (NOMI). Due to his hemodynamic instability, we decided to resect the necrotic jejunum and duodenum without anastomosis and wound closure. We performed the second operation on day 3. The duodenal necrosis extended to the 3rd portion, so we added partial duodenectomy and performed duodeno-jejuno anastomosis. Here, we report a rare case of NOMI with duodenal necrosis.
