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[Non-occlusive mesenteric ischemia].

S C Krämer1, J Görich, F Oertel

  • 1Institut für Klinische Radiologie, Universitätsklinikum Münster. kraemers@uni-muenster.de

Rofo : Fortschritte Auf Dem Gebiete Der Rontgenstrahlen Und Der Nuklearmedizin
|September 10, 2003
PubMed
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Non-occlusive mesenteric ischemia (NOMI) is a severe condition affecting elderly patients, often triggered by cardiac issues. Early diagnosis and combined treatment of vasodilators and surgery improve survival rates.

Area of Science:

  • Vascular Surgery
  • Gastroenterology
  • Critical Care Medicine

Background:

  • Non-occlusive disease (NOD), or non-occlusive mesenteric ischemia (NOMI), is a critical condition with high mortality.
  • It predominantly affects elderly patients with comorbidities like reduced cardiac output, diabetes, and renal insufficiency.
  • Cardiac decompensation or shock following heart surgery frequently triggers splanchnic vasoconstriction leading to NOMI.

Purpose of the Study:

  • To highlight the challenges in early diagnosis of NOMI due to non-specific symptoms.
  • To emphasize the critical role of early diagnosis and timely intervention in improving patient outcomes.
  • To discuss current diagnostic and therapeutic strategies for NOMI.

Main Methods:

  • Diagnosis relies on early recognition of unspecific symptoms like abdominal pain and ileus.

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  • Laboratory findings such as leucocytosis and elevated lactate levels are supportive but not definitive.
  • Immediate angiographic examination is crucial for diagnosis and guiding treatment, often revealing the need for transarterial medication.

    • Main Results:

    • Survival rates for NOMI rarely exceed 50% even with optimal care.
    • Early diagnosis is hampered by non-specific symptoms and delayed laboratory markers.
    • Angiography is the definitive diagnostic tool, enabling targeted treatment.

    Conclusions:

    • NOMI is a severe pathology with a poor prognosis, particularly in the elderly.
    • A combination of transarterial vasodilatory medication and surgical resection of necrotic bowel offers the most promising therapeutic approach.
    • Improved survival rates are achievable with early diagnosis and combined therapeutic strategies.