Non-occlusive Mesenteric Ischemia of the Antethoracic Jejunum after Esophageal Reconstruction following Subtotal Esophagectomy

Abstract

A 65-year-old man diagnosed with adenocarcinoma of the esophagogastric junction underwent subtotal esophagectomy, total gastrectomy, antethoracic reconstruction using the pedunculated jejunum, jejunum using supercharge and drainage techniques. On the 7th postoperative day (POD), he developed pneumonia. On the 8th POD, the antethoracic jejunal tissue was distended and blood tests showed elevated inflammatory biomarkers.

Contrast-enhanced CT scan revealed a swollen antethoracic jejunum with less contrast enhancement and a misty mesentery. Gastrointestinal endoscopy revealed an edematous, erythematous jejunal mucosa with multiple erosions.

Three-dimensional CT angiography revealed a patent antethoracic jejunal artery, indicating ischemic jejunitis due to non-occlusive mesenteric ischemia (NOMI) with contraction of the atrait artery of the jejunum, which might be caused by pneumonia. Because there was no evidence of necrosis of the antethoracic jejunum, the patient was conservatively treated for pneumonia and hypovolemia. On the 13th POD, NOMI resolved. Although NOMI of the reconstructed organ can occasionally develop after esophagectomy, conservative therapy may be effective in selected patients in whom NOMI is diagnosed early.