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Nonocclusive mesenteric ischemia after cardiopulmonary bypass
Tadashi Omoto1, Kentaro Kamiya, Samu Akita
1Department of Cardiovascular Surgery, International Medical Center of Japan, 1-21-1 Toyama, Shinjuku-ku, Tokyo 162-8655, Japan. tkashima@imcj.hosp.go.jp
Summary
Nonocclusive mesenteric ischemia (NOMI) is a rare condition causing intestinal hypoperfusion. This case highlights NOMI development post-cardiac surgery, emphasizing the critical need for vigilance in at-risk patients.
Area of Science:
- Gastroenterology
- Vascular Surgery
- Critical Care Medicine
Background:
- Nonocclusive mesenteric ischemia (NOMI) is a rare but serious condition.
- It involves reduced blood flow to the intestines without arterial blockage.
- NOMI can occur in critically ill patients, particularly after major surgery.
Observation:
- A 79-year-old female patient developed NOMI following cardiopulmonary bypass.
- Postoperative renal insufficiency necessitated continuous venovenous hemodialysis.
- Abdominal pain and elevated laboratory markers indicated intestinal distress.
Findings:
- Selective angiography revealed diffuse superior mesenteric artery (SMA) stenosis, consistent with NOMI.
- Treatment with urokinase and prostaglandin E1 was initiated.
- Despite intervention, the patient developed disseminated intravascular coagulopathy and succumbed to multiple organ failure.
Implications:
- This case underscores the potential for NOMI in patients undergoing cardiopulmonary bypass.
- Early recognition and prompt management are crucial for improving outcomes in NOMI.
- Further research into NOMI pathogenesis and treatment strategies is warranted.