2010 Volume 62 Pages 1-5
A 55-year-old man treated with dialysis due to diabetic nephropathy developed acute abdominal pain and was brought to our hospital by ambulance. The patient was initially under observation because the symptoms were mild and enhanced computed tomography revealed no remarkable findings. However, a laparotomy was performed after 24 hours because laboratory findings indicative of inflammation were enhanced, and the abdominal pain did not improve. The laparotomy revealed discontinuous segmental intestinal ischemia, and the patient was diagnosed with non-occlusive mesenteric ischemia. A continuous intravenous infusion (0.01 μg/kg/min) of prostaglandin E1 (PGE1) was started, and the necrotic small intestine and ascending and transverse colon were resected and anastomosed. Two days after surgery, anastomotic leak due to intestinal ischemia was suggested, and a second laparotomy was performed. The intestinal ischemic changes had worsened. Therefore, additional intestine was resected, an ileostomy was performed, and the PGE1 dose was increased to 0.05 μg/kg/min. After the second surgery, the patient's general condition and intestinal ischemia improved, and the color of the ileostomy was good. However, 42 days after the second surgery, the diabetic patient died from sepsis. Thus, the continuous intravenous infusion of PGE1 and the appropriately timed resection of necrotizing bowel are necessary for treatment of non-occlusive mesenteric ischemia, and the concurrent management of pre-existing disease should not be forgotten.
