Non-occlusive Mesenteric Ischemia Caused by Vagal Reflex after Suturing a Cut Injury in the Forearm—Report of a Case—

Abstract

A 74-year-old man presented with an 8-cm cut injury due to broken glasses in the left forearm. The wound was sutured under local anesthesia (lidocaine 200mg). Just after the treatment, he developed vagal reflex, and intravenous drop infusion was started for hypotension. About 7 hours after the wound treatment, he suddenly went into shock with melena and peritoneal signs. Enhanced abdominal CT scan after circulatory resuscitation showed segmental ischemia of the bowel, while blood flows through the mesenteric arterial branches were visualized clearly. Exploratory laparotomy was performed with the presumptive diagnosis of non-occlusive mesenteric ischemia (NOMI). Intraoperative findings revealed bowel necrosis from the terminal ileum to the middle of the transverse colon, although the appendix was kept intact. Arterial pulsation of the mesenterium was good palpable. Right hemicolectomy and double-barreled ileo-colostomy were performed. Histologic findings were compatible with NOMI. NOMI usually develops as a complication of systemic circulatory failure in patients with severe cardiac disease. This seems to be the first report in Japan that vagal reflex after ordinary suture treatment for a trauma is a suspected cause of NOMI.