title: What We Can Learn from Cases of Synchronous Acute Mesenteric Obstruction and Nonocclusive Mesenteric Ischemia: How to Reduce the Acute Mesenteric Ischemia-Related Mortality Rate.
abstract: Although the survival rate of patients with ischemic heart disease has recently increased, it remains unknown why the mortality rate of acute mesenteric ischemia (AMI) remains high. Here, we report a possible method of improving the survival rate of patients with AMI obtained through 2 cases of simultaneous acute mesenteric obstruction (AMO) and nonocclusive mesenteric ischemia (NOMI). Case 1 was a 74-year-old woman with atrial fibrillation, hypertension, and dyslipidemia as underlying diseases who developed NOMI immediately after undergoing SMA thrombolysis. Case 2 was a 69-year-old man with atrial fibrillation, hypertension, chronic heart failure, chronic renal failure, and old myocardial infarction who was diagnosed with SMA occlusion complicated by NOMI on the basis of abdominal angiography findings during the first visit. Cure was achieved by thrombolytic therapy, resection of the necrotic intestine, and continuous intra-arterial and/or intravenous injection of prostaglandin E1 (PGE1) in case 1 and by resection of the necrotic intestine and continuous intra-arterial and/or intravenous injection of PGE1 in case 2. AMO and NOMI have many background similarities (e.g., atherosclerosis, hypertension, and ischemic heart disease), making their coexistence very likely. However, no case of AMO plus NOMI has been reported until now. It is highly probable that concomitant NOMI is overlooked in cases of AMO. When managing AMO, NOMI should be considered as a complication, which may lower the patient's potential risk of developing NOMI and contribute to improved prognosis of both AMO and AMI.
authors.affiliation: Department of Surgery, Otsu Municipal Hospital, Otsu, Shiga, Japan. Electronic address: akiram7700@yahoo.co.jp.
authors.forename: Akira
authors.initials: A
authors.lastname: Mitsuyoshi
authors.affiliation: Department of Surgery, Otsu Municipal Hospital, Otsu, Shiga, Japan.
authors.forename: Tsuyoshi
authors.initials: T
authors.lastname: Tachibana
authors.affiliation: Department of Surgery, Otsu Municipal Hospital, Otsu, Shiga, Japan.
authors.forename: Yuhei
authors.initials: Y
authors.lastname: Kondo
authors.affiliation: Department of Surgery, Otsu Municipal Hospital, Otsu, Shiga, Japan.
authors.forename: Teppei
authors.initials: T
authors.lastname: Momono
authors.affiliation: Department of Surgery, Otsu Municipal Hospital, Otsu, Shiga, Japan.
authors.forename: Hiroki
authors.initials: H
authors.lastname: Aoyama
mesh_terms: D000208:Acute Disease; D000368:Aged; D000527:Alprostadil / Q000008:administration & dosage*; D001706:Biopsy; D003131:Combined Modality Therapy; D000072226:Computed Tomography Angiography; D005260:Female; D006801:Humans; D007421:Intestine, Small / Q000098:blood supply / Q000473:pathology / Q000601:surgery*; D008297:Male; D065666:Mesenteric Ischemia / Q000150:complications / Q000000981:diagnostic imaging / Q000628:therapy*; D008641:Mesenteric Vascular Occlusion / Q000150:complications / Q000000981:diagnostic imaging / Q000628:therapy*; D061330:Multidetector Computed Tomography; D009336:Necrosis; D015912:Thrombolytic Therapy; D016896:Treatment Outcome
chemical_list: D000527:Alprostadil