Fatal non-occlusive mesenteric ischemia after esophagectomy

Abstract

Non-occlusive mesenteric ischemia (NOMI) is a disorder with an extremely high mortality. Salvage of affected patients requires early recognition and aggressive intervention to prevent intestinal gangrene. We present a case of NOMI developing after esophagectomy and discuss the pathophysiology diagnosis and therapy.

An unusual case of nonocclusive mesenteric ischemia in a young girl

“…It tends to occur mostly in the elderly patients who have low-cardiac output. [12] Myocardial infarction, ventricular dysfunction or arrhythmias, circulatory or cardiogenic shock, vasoactive drugs and heart failure are the various risk factors. [34] Nor-epinephrine and vasopressin can both lead to profound vasoconstriction of the splanchnic circulation.…”

“…[12] However, the index of suspicion must also be high for young patients with prolonged shock requiring vasopressor support. Early diagnosis of altered splanchnic blood flow in the backdrop of prolonged shock and vasopressor support could have averted the fatal outcome of a young patient.…”

“…Routine intraabdominal pressure measurement in septic shock may also help in the early detection of this fatal condition. Definitive diagnosis of NOMI however requires an arteriographic study,[2] which is costly and not widely available. Gastric mucosal tonometry is the only technique available at the bedside to measure splanchnic blood flow, but this technique certainly has limitations.…”

“…[1] It commonly occurs in an elderly person having cardiovascular disease with low-cardiac output. [2] However, our case report describes NOMI in a 21-year-old student, in all probability due to demand-supply imbalance in splanchnic circulation under vasopressor support during septic shock.…”

Non-occlusive form of acute mesenteric circulatory disorders: diagnosis and treatment

“…Тем не менее основной причиной развития ишемии кишечника при неокклюзионной форме ОНМзК является его гипоперфузия с висцеральной вазоконстрикцией на уровне артериол и прекапилляров, но при проходимых брыжеечных артериях [2,30]. Среди гуморальных факторов, участвующих в патогенезе деструкции кишечной стенки при этой форме ОНМзК, предполагаются активация системы комплемента и ренинангиотензиновой системы, синтеза вазопрессина гипофизом и ряда вазоактивных пептидов (ангиотензин) [9,12,36,43,50]. Вазопрессин является одним из наиболее активных агентов, влияющих на угнетение висцерального кровотока [10,48], действие его значительно усиливается на фоне нарушений функции печени [62].…”