Nonocclusive mesenteric ischemia and heart failure: A case report and bowel ischemia imaging

Abstract

Introduction: Mesenteric ischemia is caused by blood flow that is insufficient to meet the metabolic demands of visceral organs. When severe and prolonged, it leads to intestinal necrosis, and eventually patient death. Nonocclusive mesenteric ischemia comprises all forms of mesenteric ischemia with patent mesenteric vessels. Many etiologies have been associated: shock, heart failure, use of vasopressors. A high index of suspicion is required, since initial symptoms are vague, being the most common a gradually worsening abdominal pain. Abdominal computed tomography (CT) angiography makes the diagnosis, showing signs of bowel ischemia in the face of patent mesenteric vessels. Treatment is based on correction of the underlying cause, supportive therapy, vasodilation, and surgery. Even when treated, nonocclusive mesenteric ischemia has a mortality rate of 73-86%, being the deadliest type of acute mesenteric ischemia (AMI). Case Report: The authors present a challenging case of AMI, in an elderly woman, with multiple cardiovascular risk factors and comorbidities. In the light of the clinical picture and the absence of mesenteric vessels obstruction, in the abdominal CT, a nonocclusive cause due to heart failure was