Intestinal gangrene without apparent vascular occlusion

Nonocclusive Mesenteric Ischemia After Aorto-Iliac Reconstruction of a Ruptured Abdominal Aortic Aneurysm: Report of a Case

“…5 Laparotomy usually shows segmental and diffuse necrotic changes of the intestine. 6 Because we did not find any histological evidence of thrombus in the main arteries and veins, 6 we diagnosed NOMI in our patient. According to a number of reports, NOMI represents 10%-30% of all underlying cases of acute mesenteric ischemia 5,7,8 and results in mortality in as many as 70%-95% of cases.…”

“…According to a number of reports, NOMI represents 10%-30% of all underlying cases of acute mesenteric ischemia 5,7,8 and results in mortality in as many as 70%-95% of cases. [5][6][7][8] Several causes of NOMI have been suggested, including persistent mesenteric vasoconstriction, 9 intestinal hypoxia, 4 ischemia-reperfusion injury, 10 increased intestinal metabolic demand, 11,12 and infection. 13 We thought that mesenteric vasoconstriction occurred in our patient in response to hypovolemic shock, intestinal hypoxia, and ischemia-reperfusion injury after the reconstruction.…”

Recurrent nonocclusive mesenteric ischemia after resection of iliac artery aneurysm

“…In the present patient, all of the ischemic lesions had already existed at the time of the first ischemic event. Besides, the angiographic and histological findings fulfilled the diagnostic criteria put forward by Fogarty and Fletcher 1 and Heer et al 2 Based on all the evidence, these ischemic events seemed to have been caused by NOMI.…”

“…8 NOMI is usually diagnosed based on the criteria reported by Fogarty and Flectcher 1 and Heer et al, 2 outlined in the Introduction. Early diagnosis depends on three important points: (1) recognition of patients at risk, (2) recognition that a disparity between the severity of the abdominal pain and the paucity of significant abdominal findings is characteristic of early acute mesenteric ischemia, (3) recognition that the dangers of waiting for definite physical signs or roentgenologic signs of ischemia outweigh the risks of early invasive studies in patients in whom acute mesenteric ischemia is a real possibility. 8 Mesenteric angiography demonstrating vasoconstriction is the most reliable diagnostic tool.…”

“…Usually, NOMI is diagnosed according to three circumstances, reported by Fogarty and Fletcher 1 and Heer et al, 2 as follows: (a) intestinal infarction without apparent occlusion in the mesenteric vessels; (b) segmental, discrete, or diffuse intestinal ischemic lesions; and (c) hemorrhagic necrosis without fibrin thrombi. Some series have reported that NOMI accounts for 12% to 50% of acute mesenteric ischemia, and the mortality rate is still high, although diagnostic techniques and vasodilator drug therapy have been improving.…”