title: Non-occlusive mesenteric ischemia and its associated intestinal gangrene in acute pancreatitis.
abstract: OBJECTIVE
  Non-occlusive mesenteric ischemia (NOMI) has been defined as diffuse intestinal ischemia that often results in intestinal gangrene in the presence of a patent arterial trunk. The prevalence and nature of NOMI in acute pancreatitis was investigated.
  
  
  METHODS
  A total of 120 consecutive patients with acute pancreatitis managed in the Department of Surgery II, Kumamoto University Medical School, from April 1992 through December 2002, were investigated retrospectively. Among them, 60 patients had the severe form.
  
  
  RESULTS
  The overall mortality of acute pancreatitis patients was 8.3% (10/120). The prevalence and mortality of acute pancreatitis associated with NOMI were 6.7% (8/120) and 63% (5/8), respectively, while those of patients with NOMI-associated intestinal gangrene were 4.2% (5/120) and 100% (5/5), respectively. The mortality of patients with severe acute pancreatitis who did not develop NOMI was 10% (5/52). All patients with NOMI-associated intestinal gangrene quickly progressed and subsequently died of multiple organ failure. Plasma creatine phosphokinase (CPK) and lactate levels were elevated significantly in patients with NOMI.
  
  
  CONCLUSIONS
  Acute pancreatitis associated with NOMI was extremely severe. If the plasma CPK and lactate levels are extremely high, NOMI should be suspected.
authors.affiliation: Department of Surgery II, Kumamoto University Medical School, Kumamoto City, Kumamoto, Japan.
authors.forename: Masahiko
authors.initials: M
authors.lastname: Hirota
authors.forename: Kotaro
authors.initials: K
authors.lastname: Inoue
authors.forename: Yu
authors.initials: Y
authors.lastname: Kimura
authors.forename: Takao
authors.initials: T
authors.lastname: Mizumoto
authors.forename: Kinumo
authors.initials: K
authors.lastname: Kuwata
authors.forename: Masaki
authors.initials: M
authors.lastname: Ohmuraya
authors.forename: Takatoshi
authors.initials: T
authors.lastname: Ishiko
authors.forename: Toru
authors.initials: T
authors.lastname: Beppu
authors.forename: Michio
authors.initials: M
authors.lastname: Ogawa
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000792:Angiography; D002648:Child; D002675:Child, Preschool; D005260:Female; D005734:Gangrene / Q000000981:diagnostic imaging / Q000209:etiology*; D006801:Humans; D007410:Intestinal Diseases / Q000000981:diagnostic imaging / Q000209:etiology*; D007511:Ischemia / Q000000981:diagnostic imaging / Q000209:etiology* / Q000503:physiopathology; D008297:Male; D008875:Middle Aged; D010179:Pancreas / Q000000981:diagnostic imaging / Q000473:pathology; D010186:Pancreatic Function Tests; D019283:Pancreatitis, Acute Necrotizing / Q000150:complications* / Q000000981:diagnostic imaging / Q000401:mortality; D011169:Portal Vein / Q000000981:diagnostic imaging; D013152:Splanchnic Circulation / Q000502:physiology*; D014057:Tomography, X-Ray Computed