A 75–year–old woman with aortic stenosis underwent major cardiac surgery. On day 6 after the surgery, she complained of abdominal pain and her serum lactate level increased. Abdominal CT scan ...revealed extensive mural pneumatosis of the small bowel and the presence of gas in the portal and superior mesenteric veins. Based on the findings, she was diagnosed as having non–occlusive mesenteric ischemia (NOMI) and emergency laparotomy was performed. Extensive ischemia was observed in a discontinuous manner in the small bowel. Two independent portions of the small bowel that were determined as being necrotic were resected, leaving 180 cm of healthy small bowel between the resected bowel, with jejunostomy on the distal stump. The proximal jejunal and distal ileal stumps were closed and the intestinal contents were drained through an ileus tube and the anus, respectively. The mucosal surface of the remaining small bowel was endoscopically observed on day 10 after the laparotomy, which revealed no further ischemic damage. After the general condition of the patient became stable, small bowel reconstruction was performed on day 21 after the 1st surgery. The postoperative course after the 2nd surgery was uneventful, and the patient was discharged from the hospital on day 49 after the 1st laparotomy. The serum albumin level returned to 3.9 g/dL of, the same level as that recorded prior to the cardiac surgery at 11 months after discharge. This case highlights the importance of preserving portions of the small bowel that do not show ischemic injury, to prevent short bowel syndrome.
Non-occlusive mesenteric ischemia (NOMI) is an acute mesenteric circulatory disorder that does not involve the organic occlusion of blood vessels and is associated with extremely high mortality. In ...1974, Siegelman addressed angiographic criteria for the diagnosis of mesenteric vasospasm, which was gold standard for NOMI diagnosis. But the bowel ischemia diagnosis of objective examinations was improved for recent progress of multidetector-row computed tomography and ultrasonography. Therefore the new standard establishment of diagnosis of NOMI is expected. NOMI had no particular symptom, so this diagnosis was so late at severe conditions. If the patient was diagnosed for NOMI, the indication of intravenous vasodilative medication was performed for no symptom of peritonitis, and for peritonitis, surgery should be performed. Therefore construction of standardization and treatment new algorithm of the diagnosis of NOMI is desired.
The mechanism and pathology of patients with severe acute pancreatitis with non-occlusive mesenteric ischemia (NOMI) are still unclear. Currently, there are some reports that vasoconstriction ...associated factors (angiopoietin-2, endothelin-1 and VEGF et al. ) have important role in the development of NOMI with severe acute pancreatitis. In our experience, one of characteristic pathological findings of NOMI is the non-consecutive enterointestinal damage. The diagnosis of NOMI is not easy in the early stage, so we attempt to use hepatic perfusion CT to diagnose it. Hepatic perfusion CT can evaluate hepatic portal flow (HPF) and hepatic arterial flow (HAF), separately. In our study, HPF of acute pancreatitis patients with NOMI was significantly slower than those without NOMI. Therefore, evaluation of hepatic perfusion in the early stage might be extremely helpful in the diagnosis of NOMI. In this paper, we would like to report the mechanism, pathology, diagnosis and treatment of NOMI in severe acute pancreatitis.
A 31-year-old woman with no basic disease was brought to our hospital by ambulance because with shock due to bleeding after giving birth. Angiography showed bleeding from the left uterine artery, so ...we coiled the point. A CT scan after the interventional radiology showed uterine rupture and persistent bleeding. We therefore performed an emergency operation to remove the ruptured uterus. Intraoperatively, a segmental ischemic change in small intestine was revealed and we resected approximately 50cm of the nonviable terminal ileum. Histopathological findings revealed no thrombus, and embolization in the main arteries and veins were observed in the excised specimen. We finally diagnosed the patient's condition as non-occlusive mesenteric ischemia. The postoperative course was uneventful. She fully recovered and was discharged 18 days after the operation. We experienced a case of NOMI in a young woman who fell into hemorrhagic shock due to uterine rupture after giving birth. Our findings suggest that we have to take NOMI into consideration when we examine the unstable circulatory dynamics of patients who not only have multiple complications case but are also young.
Si ricordano le iscrizioni pubblicate per merito di Henri Treziny e si ripercorre la bibliografia su due nomi personali, l’unico femminile noto a Megara Iblea e il secondo inesistente.
The ...inscriptions published thanks to Henri Tréziny are remembered, and two personal names are used to retrace the bibliography: the first being the only female known in Mégara Hyblaea and the second non-existent.
We report the case of a 58-year-old man being treated with nivolumab for recurrent Hodgkin lymphoma. He arrived at the hospital on emergency admission because of vomiting on the 5th day of ...chemotherapy and severe abdominal pain the following day. After admission, the patient continued to experience strong tenderness in the right lower abdomen with a tendency to worsen, and blood tests showed elevated white blood cell and C-reactive protein levels ; contrast-enhanced computed tomography revealed a partial contrast-impaired area in the ileum of the small intestine, and blood flow was maintained in the SMA main stem. Indocyanine green fluorescence was used to assess blood flow and determine the extent of resection, and a partial small bowel resection anastomosis was performed. Postoperatively, the patient developed paralytic ileus, but he improved with conservative treatment and was discharged. In recent years, there have been several reports of non-occlusive mesenteric ischemia (NOMI) development during chemotherapy, but none during nivolumab administration. In this report, we describe a case of NOMI during treatment with nivolumab for recurrent Hodgkin's lymphoma, which was successfully treated surgically. Thus, surgical treatment saved our patient's life.
We report an 88-year-old man suffering from repetitive non-occlusive mesenteric ischemia (NOMI) accompanied with bradycardia and portal venous gas. He was admitted to hospital with acute onset ...epigastralgia and vomiting. Consciousness was clear, but he was pale and had a cold sweat. Vital signs were normal except for sinus bradycardia (HR 42). Abdominal CT revealed portal venous gas. Over 14 months, he had three recurrences of symptoms. We administered a muscarinic antagonist that improved the symptoms at the first and the second recurrence; however, at the third recurrence, the antagonist was ineffective, and the patient had increased portal venous gas, intestinal intramural gas, and hyperlacticacidemia. We performed emergent operation because of the possibility of bowel necrosis. Intraoperative laparoscopy revealed no obvious necrosis, and indocyanine green fluorography revealed no vascular insufficiency. These findings suggested the involvement of NOMI in acute mesenteric ischemia. After surgery, isosorbide dinitrate transdermal patch was administered to prevent NOMI by inhibiting mesenteric artery spasm. A 4-year follow-up revealed no recurrence of NOMI. We report the first case of repetitive NOMI accompanied with bradycardia and portal venous gas and its successful treatment.
Non-occlusive mesenteric ischemia (NOMI) after cardiovascular surgery is a disease with a poor prognosis that is difficult to diagnose and treat. We report a case of NOMI diagnosed and treated ...immediately after open heart surgery. A 77-year-old man was admitted to our hospital due to heart failure. Echocardiography showed the diagnosis of severe aortic stenosis. He underwent surgery for the replacement of the aortic valve. After surgery, the hemodynamics became unstable and lactate continued to rise. Contrast abdominal computed tomography revealed a smaller SMV sign and ischemic area in the intestinal wall. We suspected NOMI, and continuous intravenous administration of prostaglandin was started. Angiography revealed scattered vascular stenosis in the superior and inferior mesenteric arteries, which led to the diagnosis of NOMI, and selective infusion of papaverine hydrochloride was started. Thereafter, hemodynamic improvement was observed and the patient was able to survive. To facilitate early diagnosis and treatment of NOMI, it is important to establish a protocol at the time of onset of illness to ensure smooth treatment.
L’articolo illustra le linee generali di un recente progetto di ricerca dedicato allo studio dei nomi di persona nell’Italia del basso medioevo, evidenziando il potenziale di una fonte storica fino ...ad oggi sottoutilizzata.
The patient was an 83-year-old woman who presented with sudden-onset abdominal pain. She came to our hospital with progressive symptoms and exhibited severe muscle guarding, bloody stool, and ascites ...on an imaging study. Progressive bowel infarction accompanied with panperitonitis was suspected and the patient underwent an emergency operation. Following entry of the abdominal cavity, since the thickened intestinal wall was palpated primarily at the left side colon, a colostomy was placed at the anal side and mucosal side necrosis was recognized. The extent of resection was determined based on the macroscopic findings and the palpation. However, mucosal side necrosis was evident in the specimen, and the oral stump remained necrotic. Accordingly, the extent of resection was considered using intraoperative colonoscopy, and appropriate resection of the remnant necrotic intestine was achieved. The patient was finally diagnosed as having nonocclusive mesenteric ischemia. The consideration of resection of the intestine without penetrating necrosis occurs occasionally in some cases of emergency operation for ischemic intestinal disease. Therefore, intra-operative colonoscopy could be useful in determining the appropriate extent of intestinal resection.
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