A CASE OF NON-OCCLUSIVE MESENTERIC INFARCTION DURING ANTICOAGULANT THERAPY

Abstract

A 79-year-old woman was admitted to the hospital because of sudden onset of lower abdominal pain. She had undergone an aortocoronary bypass procedure after acute myocardial infarction at the age of 66. Thereafter she had been treated with anticoagulant agents including warfarin, and given antihyper-tensive and antiarrhythmic agents. On admission laboratory data including thrombotest (19%) showed depressed coagulability. Peritoneal signs appeared on the next day. She underwent an emergency laparotomy under a preoperative diagnosis of perforative peritonitis. The bowel wall showed a segmen-tal, diffuse necrotic change. The superior mesenteric artery was found to be patent. The histologic picture of the resected specimen revealed hemorrhagic necrosis in the mucosa and submucosa. She was diagnosed as non-occlusive mesenteric infarction (NOMI). Heparin therapy was started by continuous intravenous infusion on the postoperative day, and thereafter warfarin was started again after the beginning of oral intake. There were neither episodes of hemorrhage nor thromboembolism. No aggravation of her cardiovascular disease occurred. In the treatment of patients with abdominal pain who have had cardiovascular disease, it would be necessary to determine whether they belong to the high risk group or not as soon as possible and to conduct examinations and subsequent therapies by keeping the possibility of NOMI as well as mesenteric occlusion in mind. And it is thought that anticoagulant therapy may be ineffective for prevention of NOMI.