Abstract
We report a case of wide-ranged non-occlusive mesenteric ischemia (NOMI) associated with duodenal ischemia. A 79-year-old man underwent a stent graft replacement for thoracic aortic aneurysm. Three days after the procedure, he developed infectious enteritis associated with diarrhea and abdominal pain. Thirteen days after the procedure, abdominal distention and vomiting appeared and a computed tomography (CT) scan revealed paralytic ileus, hepatic-portal venous gas, and pneumatosis cystoideus intestinalis. Judging from the severity of the illness, we treated conservatively by decompression of the gastrointestinal tract. However, 8 hours thereafter, the patient developed shock and a CT scan demonstrated poor enhancement of the part of the small intestine. We performed an emergency laparotomy.
The intraabdominal findings showed a wide range of ischemic bowel from the duodenum to the transverse colon and we resected the necrotic bowels. The patient could not recover from the shock state and died of multiple organ failure on the postoperative day 11. Pathological examination detected no thrombus in the mesenteric arteries. Therefore, the patient was diagnosed as NOMI. This patient is the fourth case of wide-ranged NOMI associated with duodenal ischemia in the literature search and it seems to have a poor prognosis.
