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Nonocclusive Mesenteric Ischemia Rescued by Immediate Surgical Exploration in a Boy with Severe Neurodevelopmental

Manami Mizumoto1, Fumihiro Ochi1, Toshihiro Jogamoto1

  • 1Department of Pediatrics, Ehime University Graduate School of Medicine, Shitsukawa, Toon, Ehime 791-0295, Japan.

Case Reports in Pediatrics
|March 28, 2019
PubMed
Abstract

Insights

Nonocclusive mesenteric ischemia (NOMI), a rare condition in children, can cause severe intestinal damage. Prompt surgical intervention is crucial for survival in pediatric patients presenting with acute abdominal symptoms and NOMI.

Area of Science:

  • Pediatric Gastroenterology
  • Surgical Innovation
  • Critical Care Medicine

Background:

  • Nonocclusive mesenteric ischemia (NOMI) is acute intestinal ischemia without arterial occlusion, often caused by vasoconstriction.
  • NOMI predominantly affects adults over 50, with rare pediatric cases reported.
  • Underlying conditions and severe illness increase NOMI risk.

Observation:

  • A 15-year-old boy with neurodevelopmental disability presented with acute abdominal symptoms, including distention and dyspnea.
  • Radiological and laboratory findings suggested intestinal obstruction and prerenal failure, progressing to shock.
  • Emergent laparotomy revealed extensive jejunal to colonic necrosis, confirming NOMI despite palpable peripheral arterial pulsations.

Findings:

  • Surgical resection of necrotic bowel and creation of stomas were performed.
  • The patient experienced a prolonged hospital stay (334 days) due to short bowel syndrome.
  • NOMI diagnosis in children necessitates considering underlying conditions and prompt surgical evaluation.

Implications:

  • NOMI must be included in the differential diagnosis for pediatric patients with severe abdominal conditions.
  • Early surgical exploration is vital for NOMI management and improving patient outcomes.
  • This case highlights the importance of recognizing NOMI in critically ill children with gastrointestinal distress.

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