Tube Enteral Feeding-Associated Non-Occlusive Mesenteric Ischemia following Gastric Cancer Surgery: A Retrospective...

Area of Science:

• Gastroenterology
• Surgical Oncology
• Abdominal Imaging

Background:

• Non-occlusive mesenteric ischemia (NOMI) is a rare, life-threatening complication post-gastric cancer (GC) surgery.
• It involves intestinal hypoperfusion without arterial blockage, presenting with vague symptoms and rapid decline.
• Timely diagnosis is challenging, impacting patient outcomes significantly.

Purpose of the Study:

• To evaluate the outcomes, diagnostic methods, and management strategies for NOMI in GC patients.
• To assess the impact of a modified feeding protocol on NOMI incidence.
• To identify critical factors for improving survival rates.

Main Methods:

• Retrospective review of eight GC patients diagnosed with NOMI between February 2022 and January 2024.
• Data collected included demographics, surgical specifics, feeding practices, clinical presentation, imaging findings (CT), treatment, and mortality.
• Primary endpoint was 30-day mortality.

Main Results:

• NOMI occurred a median of 3 days post-surgery in advanced GC patients, predominantly males with gastric outlet obstruction.
• Clinical signs included abdominal distension, hypotension, and peritonitis.
• CT revealed small-bowel dilatation, pneumatosis intestinalis, and portal venous gas.
• Five of seven re-explored patients required bowel resection.
• A modified feeding protocol correlated with a significant reduction in NOMI cases (7 to 1).
• Thirty-day mortality was 50%, primarily due to sepsis and multiple organ dysfunction syndrome (MODS).

Conclusions:

• NOMI remains a severe complication in GC patients, particularly those with feeding jejunostomy.
• A cautious feeding strategy, including delayed feeding during vasopressor use and gradual diet advancement, may reduce NOMI incidence.
• High clinical suspicion, prompt CT imaging, and timely surgical intervention are crucial for improving patient outcomes.