SUCCESSFUL TREATMENT OF AN ELDERLY PATIENT WITH NON-OCCLUSIVE MESENTERIC ISCHEMIA

Abstract

A 94-year-old woman was admitted to our hospital because of vomiting and abdominal distension. Although laboratory examination indicated relatively non-severe condition, abdominal plain X-ray film and CT scan showed dilatation and wall thickening of the small intestine. On admission, the woman went into shock. An emergency surgery was initiated with a diagnosis of acute abdomen. Operative findings showed regional necrosis of the small intestine extending 150cm from a point 50cm distal from the Treitz's ligament. The total resection of the necrotic small intestine and jejuno-ileostomy by side to side was performed. Pathological examination showed no signs of thrombus, fibrinoid degeneration, or angitis in blood vessels of the small intestine, and non-occlusive mesenteric ischemia (NOMI) was diagnosed. The patient, in septic shock and multiple organ failure before surgery, was managed with respirator, direct hemoperfusion using polymyxin-B immobilized fiber (PMX-DHP), and hemodiafiltration (HDF). Consequently, the patient could take food orally on postoperative day (POD) 7, and she was discharged on POD 48.