A Case of Septicemia due to Nonocclusive Mesenteric Ischemia Occurring in Induction Chemotherapy

Abstract

In nonocclusive mesenteric ischemia (NOMI), mesenteric ischemia and intestinal necrosis occur despite the absence of organic blockage in mesenteric blood vessels. As abdominal pain is often absent and few characteristic findings are seen in blood biochemistry, imaging diagnosis or other examinations, discovery is often delayed. With a mortality rate of 56–79%, NOMI is a very serious disease. However, few reports have described this pathology in association with chemotherapy regimens such as those used for malignant head and neck tumors. We encountered a case of NOMI during induction therapy combining cisplatin, docetaxel, and 5-fluorouracil. The patient was a 74-year-old man receiving chemotherapy for T2N2bM0 stage IVA oropharyngeal carcinoma. Febrile neutropenia appeared on treatment day 8. An antibacterial agent and a granulocyte colony-stimulating factor were administered, but septic shock developed and he was transferred to the intensive care unit. Abdominal distension was present and contrast-enhanced computed tomography of the abdomen suggested NOMI. Emergency surgery on day 9 resected the necrotized small intestine and created a single-hole ileostomy. The patient subsequently recovered with 2 weeks of continuous hemodiafiltration and other intensive therapies. Otolaryngological surgeons seldom encounter intestinal diseases, which are thus easily overlooked. The present case report may help in achieving early diagnosis.

Morbidity and Mortality of Neutropenic Patients in Visceral Surgery: A Narrative Review

“…Right-sided abdominal pain and diarrhea, particularly bloody diarrhea, might also be caused by non-occlusive mesenteric ischemia (NOMI), which typically occurs in patients with circulatory disorders, but is also reported in neutropenic patients [ 54 ]. For example, Tanaka et al reported about a 74-year-old man diagnosed with oropharyngeal carcinoma who developed febrile neutropenia followed by septic shock due to NOMI on day 9 of chemotherapeutic treatment [ 55 ]. The occurrence of NOMI is a life-threatening event affecting particularly critically ill patients and showing a mortality rate up to 60% [ 54 ].…”

A Case of Nonocclusive Mesenteric Ischemia During Bioradiotherapy With Cetuximab

“…The number of cases of NOMI after chemotherapy is not high [ 14 - 18 ]. Among them, seven patients have developed NOMI after chemotherapy for head and neck cancer, and most cases of NOMI developed after docetaxel, cisplatin, and fluorouracil (TPF) therapy [ 15 - 18 ] (Table 1 ).…”

“…The number of cases of NOMI after chemotherapy is not high [14][15][16][17][18]. Among them, seven patients have developed NOMI after chemotherapy for head and neck cancer, and most cases of NOMI developed after docetaxel, cisplatin, and fluorouracil (TPF) therapy [15][16][17][18] The pathogenesis of NOMI caused by TPF therapy (docetaxel, cisplatin, and fluorouracil) is speculated to be due to the pharmacological effects of taxanes, such as mucosal damage caused by the mitotic proliferation of epithelial components and vascular damage caused by the inhibition of smooth muscle cell proliferation, migration, and neointimal accumulation, in addition to increased intestinal pressure caused by intestinal inflammation due to 5-fluorouracil and constipation [18,19].…”

Nonocclusive Mesenteric Ischemia after Introduction of Chemotherapy for Esophageal Cancer: Report of Two Cases and Review of the Literature

“…To date (2020), only seven cases of NOMI during chemotherapy have been reported. (Table 1) [3][4][5][6][7]. Seven of the now nine reported cases (including the current cases) were elderly individuals over 70 years of age (median age, 74 years; range, 63-80 years), with no specific commonality in their medical history.…”

“…The main risk factors for NOMI include advanced age, dialysis, heart failure, use of certain drugs (digitalis, diuretics, catecholamines), arrhythmia, diabetes, and dehydration [2]. A few cases of NOMI that developed in patients with cancer after administration of chemotherapy have been reported [3][4][5][6][7]. Development of NOMI after administration of chemotherapy for esophageal cancer has not been reported to our knowledge.…”