Fatal nonocclusive mesenteric ischaemia: population‐based incidence and risk factors

Abstract

Abstract. Acosta S, Ö gren M, Sternby N-H, Bergqvist D, Björck M (Malmö University Hospital, Malmö; and Uppsala University Hospital, Uppsala; Sweden). Fatal nonocclusive mesenteric ischaemia: population-based incidence and risk factors. J Intern Med 2006; 259: 305-313.Objectives. To estimate the incidence and extension of visceral organ infarction, and to evaluate potential causes, in patients with autopsy-verified nonocclusive mesenteric ischaemia (NOMI) and transmural intestinal infarction. Setting. In Malmö, Sweden, the autopsy rate between 1970 and 1982 was 87%, creating possibilities for a population-based study. Design. Amongst 23 446 clinical autopsies, 997 cases were coded for intestinal ischaemia in a database. In addition, 7569 forensic autopsy protocols were analysed. In a nested case-control study within the clinical autopsy cohort, four NOMIfree controls, matched for gender, age at death and year of death, were identified for each fatal NOMI case to evaluate risk factors.Results. The overall incidence of autopsy-verified fatal NOMI was 2.0/100 000 person-years, increasing with age up to 40/100 000 personyears in octogenarians. Patients with stenosis of the superior mesenteric artery (SMA; n ¼ 25) were older (P ¼ 0.002) than those without (n ¼ 37), and had more often a concomitant stenosis of the coeliac trunk (P < 0.001). Synchronous infarction in the liver, spleen or kidney occurred in one-fifth of all patients. Fatal cardiac failure 2)], history of atrial fibrillation [OR 2.2 (1.2-4.0)] and recent surgery )] were risk factors for fatal NOMI. Conclusions. Fatal heart failure was the leading cause of intestinal hypoperfusion, although stenosis of the SMA and coeliac trunk, atrial fibrillation and recent surgery contributed significantly. Collaboration across specialties seems to be of utmost importance to improve the prognosis.

Fatal Diarrheal Disease Caused by <i>Vibrio cholerae</i> O67 in a Patient with Myelodysplastic Syndrome

“…NOMI is primarily involved in states of hypoperfusion, including circulatory failure, surgery, hemodialysis and sepsis. On admission, the patient was also at high risk of NOMI, as previously reported (18,19). In addition, the intestinal ischemia was thought to have worsened due to dehydration lasting for a long period of time prior to admission.…”

“…Our autopsy findings showed that the intestinal blood flow was inadequate from the jejunum through the descending colon without thromboembolic occlusion of the mesenteric arteries or veins. The segmental intestinal ischemic changes observed in this case appeared to be associated with nonocclusive mesenteric ischemia ( NOMI ) due to vascular spasms (18,19). NOMI is primarily involved in states of hypoperfusion, including circulatory failure, surgery, hemodialysis and sepsis.…”

Acute mesenteric ischemia after cardio-pulmonary bypass surgery

“…No vascular occlusion is usually demonstrated because pulsatile blood flow is present in larger arteries [8] . There are several predisposing factors, which are often interrelated, such as heart failure, arterial hypotension, elevated sympathetic activity, hypovolemia, sepsis, use of vasopressors and preexisting atherosclerotic lesions [7] . Catecholamines and medications such as digitalis [9] , by interfering with the auto-regulation of mesenteric circulation, can also cause vasospasm [10] .…”

“…In NOMI, diffuse vasospasm of the mesenteric and other visceral arteries occurs as a result of a sustained hypoperfusion state [6,7] . No vascular occlusion is usually demonstrated because pulsatile blood flow is present in larger arteries [8] .…”

Intrapleural and Intraperitoneal Free Fluid in Calcium Channel Blocker Overdose

“…The presence of variable amounts of collaterals makes the colon susceptible to ischemia (15). Depending on the CCB overdose, although complicated and surgery-requiring complications such as submucosal edema, ischemia, necrotic ulceration, bleeding, and even gangrene have been observed in case reports in the literature, clinical situations, such as pseudo-obstruction, that can be treated without surgical treatments have also been shown (2,10).…”