Nonocclusive mesenteric ischemia after cardiopulmonary bypass.
Nonocclusive mesenteric ischemia (NOMI) is a rare abdominal pathology caused by mucosal hypoperfusion without actual obstruction to the mesenteric arteries. We present a case of NOMI after a cardiopulmonary bypass operation. The patient was a 79-year-old woman with a history of hypertension and diabetes mellitus. A coronary bypass operation was performed with stable hemodynamic conditions, and continuous venovenous hemodialysis was performed on the second postoperative day because of renal insufficiency. After 24 h of hemodialysis, the hematocrit level increased from 29.1% to 36.1%. The patient had some vague abdominal pain on the third postoperative day with abnormal laboratory values: leukocytes 17.10 x 10(3)/microl, creatine kinase 1085 U/l, glutamic-oxyloacetic transaminase 6188 U/l, and lactate dehydrogenase 8695 U/l. Selective angiography showed diffuse stenosis of the superior mesenteric artery (SMA) without any occlusive findings on the major branches; the patient was therefore diagnosed with NOMI. An infusion of urokinase and prostaglandin E1 was started; however, disseminated intravascular coagulopathy had developed and the patient died on the 21st postoperative day as a result of multiple organ failure. The autopsy demonstrated extensive necrosis and hemorrhage in the small intestine without any occlusive findings on the major branches of the SMA.
Omoto
Tadashi
T
Department of Cardiovascular Surgery, International Medical Center of Japan, 1-21-1 Toyama, Shinjuku-ku, Tokyo 162-8655, Japan. tkashima@imcj.hosp.go.jp
Kamiya
Kentaro
K
Akita
Samu
S
Sugiyama
Kayo
K
Kume
Masato
M
Kashima
Toshitaka
T
Hosaka
Shigeru
S
Kimura
Sosuke
S
D000368:Aged; D002315:Cardiopulmonary Bypass; D003251:Constriction, Pathologic; D017809:Fatal Outcome; D005260:Female; D006400:Hematocrit; D006801:Humans; D007511:Ischemia / Q000503:physiopathology*; D007583:Jejunum / Q000098:blood supply / Q000473:pathology; D017538:Mesenteric Artery, Superior / Q000000981:diagnostic imaging / Q000473:pathology*; D008643:Mesentery / Q000098:blood supply*; D010960:Plasminogen Activators / Q000627:therapeutic use; D011859:Radiography; D014568:Urokinase-Type Plasminogen Activator / Q000627:therapeutic use
D010960:Plasminogen Activators; D014568:Urokinase-Type Plasminogen Activator