Jump to ContentJump to Main Navigation
Show Summary Details

Polish Journal of Surgery

The Journal of Foundation of the Polish Journal of Surgery

12 Issues per year

SCImago Journal Rank (SJR) 2015: 0.214
Source Normalized Impact per Paper (SNIP) 2015: 0.336
Impact per Publication (IPP) 2015: 0.443

Open Access
See all formats and pricing
Volume 84, Issue 4 (Apr 2012)


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

Guenter Weiss
  • Intensive Care Unit, Department of General, Abdominal, Vascular Surgery University Hospital, Magdeburg, Germany
/ Hans Lippert
  • Intensive Care Unit, Department of General, Abdominal, Vascular Surgery University Hospital, Magdeburg, Germany
/ Frank Meyer
  • Intensive Care Unit, Department of General, Abdominal, Vascular Surgery University Hospital, Magdeburg, Germany
Published Online: 2012-06-14 | DOI: https://doi.org/10.2478/v10035-012-0035-y

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

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.

Keywords: non-occlusive mesenteric ischemia; mesentericography; intraarterial perfusion catheter; vasodilating treatment

  • Vicente DC, Kazmers A: Acute mesenteric ischemia. Curr Opin Cardiol 1999; 14(5): 453. [PubMed] [Crossref]

  • Eckstein HH: Die akute mesenteriale Ischämie. Resektion oder Rekonstruktion? Chirurg 2003; 74: 419-31.

  • Düber C, Wüstner M, Diehl SJ et al.: Bildgebung im Rahmen der Notfalldiagnostik bei mesenterialer Ischämie. Chirurg 2003; 74: 399-406.

  • Howard TJ, Plaskon LA, Wiebke EA et al.: Nonocclusive Mesenteric Ischemia Remains a Diagnostic Dilemma. Am J Surg 1996; 171: 405-08. [PubMed]

  • Lock G: Die akute mesenteriale Ischämie - häufig übersehen und häufig letal. Med Klinik 2002; 97: 402-09.

  • Sheeran SH: Acute mesenterial ischemia: recent advances in diagnosis and endovascular therapy. Emerg Radiol 2000; 7: 231-36.

  • 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.

About the article

Published Online: 2012-06-14

Published in Print: 2012-04-01

Citation Information: Polish Journal of Surgery, ISSN (Print) 0032-373X, DOI: https://doi.org/10.2478/v10035-012-0035-y. Export Citation

This content is open access.

Comments (0)

Please log in or register to comment.
Log in