A Case of Non-occlusive Mesenteric Ischemia (NOMI) Caused by Overdoses of Antihypertensive Drugs

Abstract

A 49-year-old man who had a history of bipolar affective disorder was brought into the emergency room after taking large doses of several antihypertensive drugs for suicide attempt. He had hypotension, high fever, and abdominal pain, but these symptoms rapidly subsided. However, the symptoms worsened after resuming eating, and a colonoscopy and an enterography visualized multiple irregular ulcers from the lower part of the ascending colon to the end of the ileum, and a distal ileum with marked stenosis. We determined that conservative cure could not be expected and performed surgery. A 75-cm long portion of the distal ileum was resected because of ileal discontinuous wall thickening and stenosis. The patient was discharged on 27th day after the surgery. Histopathological findings showed ulceration of the mucosa, extensive fibrosis from the submucosa to the upper layers of the muscularis mucosa, congested capillaries and veins, but no thrombus or arterial stenosis was found in any parts of the resected specimen. Therefore, we concluded that the lesion was caused by mucosal damage and fibrous stenosis in the deeper layers of the mucosa due to non-occlusive mesenteric ischemia (NOMI) caused by high doses of antihypertensive drugs.