A Case of Non-occlusive Mesenteric Ischemia Diagnosed as an Acute Colonic Pseudo-obstruction

Abstract

An 83-year-old man presented at our hospital because of complaints of constipation, abdominal pain, and a sensation of fullness in the abdomen. He was admitted with a diagnosis of obstructive ileus due to feces. The following day, the patient continued to experience abdominal pain and a sensation of fullness ; dynamic computed tomography revealed dilatation of the colon and accumulation of ascitic fluid. The patient was diagnosed with acute colonic pseudo-obstruction and underwent an emergency operation. During the procedure, a portion of the large intestine from the ascending colon to the descending colon became necrotic ; the lesion was excised, and an ileosigmoidostomy was performed. Histopathological analysis of the surgical specimens resulted in a diagnosis of non-occlusive mesenteric ischemia (NOMI). Second look surgery was not performed. The patient had a good postoperative course and was discharged 28 days post-surgery. NOMI has nonspecific physical findings, and the symptoms progress slowly thereby, often giving the impression that the disease might not be serious ; however, NOMI is a life-threatening disorder and should be considered in cases of acute abdomen.