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Fulminant nonocclusive mesenteric ischemia developing just after esophagectomy
N Hokamura1, H Kato, H Watanabe
1Department of Surgery, National Cancer Center Hospital, Tokyo, Japan. nhokamur@gan2.res.ncc.go.jp
Abstract:
Nonocclusive mesenteric ischemia (NOMI) is a poorly understood condition, marked by progressive ischemia of the intestine leading to infarction, sepsis and death. The mortality rate remains high. Three cases of NOMI occurred after esophagectomy at our facility. It was suspected, through investigation of these cases, that NOMI occurring after major surgical procedures like esophagectomy has a far more rapid and progressive clinical course and high mortality rate. Therefore, it should be distinguished from spontaneously developing NOMI. A huge water shift between the intravascular space and the extravascular space during and just after surgery is suspected to have played a major role in the development of post-operative NOMI. Diagnosis and treatment of NOMI after a major surgery are quite difficult.
Insights
Nonocclusive mesenteric ischemia (NOMI) after esophagectomy presents a rapid, severe clinical course with high mortality. Post-operative NOMI requires distinct recognition from spontaneous cases due to unique risk factors and challenges.
Area of Science:
- Gastroenterology
- Surgical Oncology
- Critical Care Medicine
Background:
- Nonocclusive mesenteric ischemia (NOMI) is a severe intestinal condition with high mortality.
- NOMI is poorly understood, often leading to infarction, sepsis, and death.
Observation:
- Three cases of NOMI were observed following esophagectomy at our institution.
- Post-operative NOMI after major surgery appears to have a more aggressive progression and higher mortality rate than spontaneous NOMI.
Findings:
- A significant fluid shift between intravascular and extravascular spaces during/after surgery is implicated in post-operative NOMI.
- Diagnosing and treating NOMI post-major surgery presents considerable difficulties.
Implications:
- NOMI following esophagectomy warrants specific consideration and potentially distinct management strategies.
- Further research is needed to elucidate the mechanisms and optimize treatment for post-operative NOMI.