title: Non-occlusive mesenteric ischemia localized in the transverse colon: a case report.
abstract: BACKGROUND
  Non-occlusive mesenteric ischemia (NOMI) is ischemia of the mesentery that is caused by hypoperfusion or vasospasm without any thrombosis. NOMI is difficult to diagnose by physical examination alone. Although angiographic examination of the superior mesenteric artery (SMA) is the usual diagnostic method used, it is an invasive examination. Usually, a long range of the bowel becomes discontinuously necrotic in NOMI. Here, we report a rare case of NOMI localized in the transverse colon that was diagnosed by computed tomography (CT) angiography which is a minimally invasive examination.
  
  
  METHODS
  A 72-year-old woman was referred to our hospital for further treatment of abdominal pain that developed 1 day before presentation. Contrast-enhanced abdominal CT scan revealed attenuated enhancement of the transverse colon. CT angiography showed SMA irregularities due to vasospasm. The middle colic artery could not be detected by CT angiography. No occlusion due to thrombus or embolism in the SMA and superior mesenteric vein was observed. Based on the findings, NOMI was suspected, and emergency laparotomy was performed, which revealed a segmentally necrotic transverse colon. The necrotic bowel was resected, and stomas were created.
  
  
  CONCLUSIONS
  The presence of hypotension in the patient necessitated the use of CT angiography, which proved very useful in the early diagnosis of the present case. Thus, if intestinal ischemia is suspected, even in case of a short segment, CT angiography should be performed.
authors.affiliation: Department of Surgical Oncology, Faculty of Medicine, The University of Tokyo, Tokyo, Japan. MURONOK-SUR@h.u-tokyo.ac.jp.
authors.forename: Koji
authors.initials: K
authors.lastname: Murono
authors.affiliation: Department of Surgical Oncology, Faculty of Medicine, The University of Tokyo, Tokyo, Japan.
authors.forename: Soichiro
authors.initials: S
authors.lastname: Ishihara
authors.affiliation: Department of Surgical Oncology, Faculty of Medicine, The University of Tokyo, Tokyo, Japan.
authors.forename: Kazushige
authors.initials: K
authors.lastname: Kawai
authors.affiliation: Department of Surgical Oncology, Faculty of Medicine, The University of Tokyo, Tokyo, Japan.
authors.forename: Manabu
authors.initials: M
authors.lastname: Kaneko
authors.affiliation: Department of Surgical Oncology, Faculty of Medicine, The University of Tokyo, Tokyo, Japan.
authors.forename: Kazuhito
authors.initials: K
authors.lastname: Sasaki
authors.affiliation: Department of Surgical Oncology, Faculty of Medicine, The University of Tokyo, Tokyo, Japan.
authors.forename: Koji
authors.initials: K
authors.lastname: Yasuda
authors.affiliation: Department of Surgical Oncology, Faculty of Medicine, The University of Tokyo, Tokyo, Japan.
authors.forename: Kensuke
authors.initials: K
authors.lastname: Otani
authors.affiliation: Department of Surgical Oncology, Faculty of Medicine, The University of Tokyo, Tokyo, Japan.
authors.forename: Takeshi
authors.initials: T
authors.lastname: Nishikawa
authors.affiliation: Department of Surgical Oncology, Faculty of Medicine, The University of Tokyo, Tokyo, Japan.
authors.forename: Toshiaki
authors.initials: T
authors.lastname: Tanaka
authors.affiliation: Department of Surgical Oncology, Faculty of Medicine, The University of Tokyo, Tokyo, Japan.
authors.forename: Tomomichi
authors.initials: T
authors.lastname: Kiyomatsu
authors.affiliation: Department of Surgical Oncology, Faculty of Medicine, The University of Tokyo, Tokyo, Japan.
authors.forename: Keisuke
authors.initials: K
authors.lastname: Hata
authors.affiliation: Department of Surgical Oncology, Faculty of Medicine, The University of Tokyo, Tokyo, Japan.
authors.forename: Hiroaki
authors.initials: H
authors.lastname: Nozawa
authors.affiliation: Department of Pathology, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan.
authors.forename: Akimasa
authors.initials: A
authors.lastname: Hayashi
authors.affiliation: Department of Pathology, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan.
authors.forename: Tetsuo
authors.initials: T
authors.lastname: Ushiku
authors.affiliation: Department of Pathology, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan.
authors.forename: Masashi
authors.initials: M
authors.lastname: Fukayama
authors.affiliation: Department of Surgical Oncology, Faculty of Medicine, The University of Tokyo, Tokyo, Japan.
authors.forename: Toshiaki
authors.initials: T
authors.lastname: Watanabe
keywords: Colon; Computed tomography angiography; Non-occlusive mesenteric ischemia; Report of a case