Non-occlusive Acute Mesenteric Ischemia in an Adult Male Patient With Diabetic Ketoacidosis

Diabetic ketoacidosis (DKA) is a medical emergency that may represent the first manifestation of diabetes mellitus. Management typically centers on fluid resuscitation, insulin therapy, and treatment of precipitating factors, but clinicians must remain alert to rare and life-threatening complications. We report a 28-year-old male with no prior history of diabetes who presented with influenza-associated DKA. Despite standard therapy, he developed worsening shock and persistent abdominal tenderness. Computed tomography of the abdomen revealed portal venous gas and pneumatosis intestinalis, prompting emergent laparotomy. Intraoperative findings confirmed extensive ischemic necrosis of the terminal ileum, right colon, and appendix, requiring resection with temporary abdominal closure. A second-look procedure 48 hours later demonstrated viable remaining bowel, and an ileo-transverse anastomosis with definitive closure was performed. The patient improved steadily, was extubated, and discharged home in stable condition. This case highlights the need for vigilance when abdominal pain or hemodynamic instability persists in DKA patients despite appropriate management. Non-occlusive mesenteric ischemia (NOMI), although rare and more often described in older individuals with vascular risk factors, can occur in young adults in the setting of profound hypovolemia and shock. Early recognition, aggressive fluid resuscitation, careful titration of vasopressors, and timely surgical intervention are critical to improving outcomes and preventing mortality in these patients.