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2012 | 84 | 4 | 214-218
Article title

Successful Management of Non-Occlusive Mesenteric Ischemia (Nomi) - Case Report

Content
Title variants
Languages of publication
EN
Abstracts
EN
Patients with non-occlusive mesenteric ischemia (NOMI) are still confronted with high mortality. The diagnostic is challenging and difficult because of the unspecific symptomatology. The aim of this systematic scientific report on an extraordinary and uncommon single clinical case and its successful course was to demonstrate the great potential of a partially novel non-surgical approach including its periinterventional management.A 73-year old female is precisely described, who developed an acute abdomen during the postoperative course after cardiosurgical intervention. Only explorative laparotomy clarified the correct diagnosis - NOMI. Despite general intensive care, patient developed multi-organ failure after this second intervention. Using consequently an image-guided minimally invasive radiological approach comprising the introduction of a catheter into the superior mesenteric artery (Seldinger's technique) and the continuous application of vasodilating medication such as alprostadil (prostaglandin) through this catheter enabled us to improve mesenteric perfusion effectively and to overcome multiorgan failure.In conclusion, specific risk factors may help to focus on the suspicion of NOMI. Diagnostic of choice is the arterial mesentericography, which allows specifically to exclude vascular occlusion including the consequence of a prompt surgical approach. Simultaneously, using the setting of the mesenteric angiography catheter can be placed for initiation of regional vasodilating treatment in case of NOMI. Only this approach may avoid fatal outcome.
Publisher

Year
Volume
84
Issue
4
Pages
214-218
Physical description
Dates
published
1 - 4 - 2012
online
14 - 6 - 2012
Contributors
author
  • Intensive Care Unit, Department of General, Abdominal, Vascular Surgery University Hospital, Magdeburg, Germany
author
  • Intensive Care Unit, Department of General, Abdominal, Vascular Surgery University Hospital, Magdeburg, Germany
author
  • Intensive Care Unit, Department of General, Abdominal, Vascular Surgery University Hospital, Magdeburg, Germany
References
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  • Wilke R, Luther B, Grabitz K et al.: Fulminante nichtokklusive mesenteriale Ischämie nach Reperfusion einer hochgradig ischämischen Extremität mit septisch-toxischer Einschwemmung. Gefässchirurgie 2002; 7: 74-81.
  • Wolf AM, Henne-Bruns D: Mesenteriale Ischämie. Chirurg 2003; 74: 395-98.
  • Trompeter M, Brazda T, Remy CT et al.: Non-occlusive mesenteric ischemia: etiology, diagnosis, and interventional therapy. Eur Radiol 2002; 12: 1179-87.[PubMed]
  • Leister I, Markus PM, Becker H: Mesenteriale Ischämie. Hat die diagnostische Laparoskopie einen Stellenwert? Chirurg 2003; 74: 407-12.
Document Type
Publication order reference
Identifiers
YADDA identifier
bwmeta1.element.-psjd-doi-10_2478_v10035-012-0035-y
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