Non-occlusive mesenteric ischemia (NOMI) is caused by ischemia and necrosis of the intestinal tract without organic obstruction of the main mesenteric artery. Accordingly, in many cases, resection of the ischemic intestinal tract is performed to save the life of the patient. However, conservative treatment has also been reported in some cases. Arterial vasodilator therapy using angiography is considered the gold standard for NOMI treatment. However, for facilities without capacity for angiography, conservative management is needed. Herein, we report a case of NOMI in an 85-year-old woman hospitalized for an odontoid process fracture. On post-admission day 14, the patient developed acute onset of epigastric pain, with evidence of hepatic portal venous gas (HPVG) on computed tomography (CT) abdominal imaging. In the absence of peritoneal irritation and findings suggestive of intestinal necrosis on blood tests, combined with the risk of cervical cord injury with intubation for surgery, we initiated continuous intravenous administration of prostaglandin E1 (PGE1, 0.01μg/kg/min) on the same day of symptom onset, achieving resolution of epigastric pain on the next day. PGE1 administration was continued to day 5 after symptom onset, with no worsening of symptoms after PGE1 discontinuation. Blood tests showed no deterioration (Fig. 1). The patient was discharged on day 63. Continuous intravenous infusion of PGE1 for NOMI may be an option for the conservative treatment of early onset or no intestinal necrosis-associated NOMI.

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