Survival in nonocclusive mesenteric ischemia: early diagnosis by multidetector row computed tomography and early treatment with continuous intravenous high-dose prostaglandin E(1).
OBJECTIVE
The aim of the study was to establish a procedure for early diagnosis and treatment of nonocclusive mesenteric ischemia (NOMI).


BACKGROUND
NOMI has a high mortality rate, and early diagnosis and treatment are important for improving survival in patients with this condition.


METHODS
The subjects were 22 patients treated at our hospital over 13 years. Diagnostic criteria for NOMI were established based on the first 13 cases. In the 9 more recent cases, we performed abdominal contrast multidetector row computed tomography (MDCT) upon suspicion of NOMI based on these criteria. Imaging allowed definite diagnosis of NOMI, and continuous intravenous high-dose PGE1 administration was initiated immediately after diagnosis (dose, 0.01-0.03 microg/kg per min; mean administration period, 4.8 days).


RESULTS
Nine of the first 13 patients died of multiple organ failure associated with multiple intestinal necrosis. These cases suggested that NOMI may develop when 3 of the following 4 criteria are met after cardiovascular surgery or maintenance dialysis in elderly patients: symptoms of the ileus develop slowly from abdominal symptoms, such as an unpleasant abdominal feeling or pain; a requirement for catecholamine treatment; an episode of hypotension; and slow elevation of the serum transaminase level. In the 9 recent cases, definite diagnosis was made from spasm of the principal arteries in arterial volume rendering and curved planar reformation MDCT images. Early treatment with PGE1 prevented acute-stage NOMI in 8 of the 9 cases.


CONCLUSIONS
Early diagnosis of NOMI is possible using the above criteria and MDCT, and initiation of PGE1 treatment may increase survival in patients with NOMI.
Department of Surgery, Mitsubishi Kyoto Hospital, Nishikyo-ku, Kyoto 615-8087, Japan. akiram7700@yahoo.co.jp
Akira
A
Mitsuyoshi
Kazutaka
K
Obama
Nobuhiko
N
Shinkura
Takashi
T
Ito
Masazumi
M
Zaima
D000368:Aged; D000369:Aged, 80 and over; D000527:Alprostadil / Q000008:administration & dosage*; D003937:Diagnosis, Differential; D004305:Dose-Response Relationship, Drug; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007262:Infusions, Intravenous; D007422:Intestines / Q000098:blood supply*; D007511:Ischemia / Q000000981:diagnostic imaging / Q000188:drug therapy / Q000401:mortality; D008297:Male; D008638:Mesenteric Arteries; D008875:Middle Aged; D015996:Survival Rate; D013997:Time Factors; D014057:Tomography, X-Ray Computed / Q000379:methods*; D016896:Treatment Outcome; D014665:Vasodilator Agents / Q000008:administration & dosage*
D014665:Vasodilator Agents; D000527:Alprostadil