[Successful management of nonocclusive mesenteric ischemia after aortic valve replacement;report of a case]

Non-occlusive mesenteric ischemia (NOMI) is a fatal complication after cardiovascular surgery, but early diagnosis is difficult because the clinical symptoms are not specific. We report a case of NOMI with successful management due to early diagnosis and treatment. A 78-year-old male complained of sudden abdominal pain after aortic valve replacement. NOMI was suspected because his laboratory work-up showed elevated serum transaminase, and computed tomography showed no mesenteric artery obstruction. We started a continuous intravenous infusion of prostaglandin E1, and performed emergency arterial angiography. Since angiography showed vasospasm of the mesenteric artery, we also started a continuous intra-arterial infusion of papaverine. Each vasodilator drug was started within a few hours after the onset of NOMI. His subsequent hospital course was uneventful, and he was discharged without enterectomy or fatal intestinal necrosis.