A Case of Non-Occlusive Mesenteric Ischemia Immediately after Open Heart Surgery

Daiki Hirayama＊	Daisuke Hiraoka＊＊	Norihisa Yuge＊
Ryoji Kinoshita＊	Yohei Yamamoto＊＊＊	Hidetoshi Uchiyama＊＊＊
Susumu Manabe＊	Mashiro Ohnuki＊＊＊	Kazunobu Hirooka＊

（Department of Cardiac Surgery, Tsuchiura Kyodo General Hospital＊, Tsuchiura, Japan, Department of Cardiovascular Surgery, Chiba University Hospital＊＊, Chiba, Japan, and Department of Vascular Surgery, Tsuchiura Kyodo General Hospital＊＊＊, Tsuchiura, Japan）

Non-occlusive mesenteric ischemia（NOMI）after cardiovascular surgery is a disease with a poor prognosis that is difficult to diagnose and treat. We report a case of NOMI diagnosed and treated immediately after open heart surgery. A 77-year-old man was admitted to our hospital due to heart failure. Echocardiography showed the diagnosis of severe aortic stenosis. He underwent surgery for the replacement of the aortic valve. After surgery, the hemodynamics became unstable and lactate continued to rise. Contrast abdominal computed tomography revealed a smaller SMV sign and ischemic area in the intestinal wall. We suspected NOMI, and continuous intravenous administration of prostaglandin was started. Angiography revealed scattered vascular stenosis in the superior and inferior mesenteric arteries, which led to the diagnosis of NOMI, and selective infusion of papaverine hydrochloride was started. Thereafter, hemodynamic improvement was observed and the patient was able to survive. To facilitate early diagnosis and treatment of NOMI, it is important to establish a protocol at the time of onset of illness to ensure smooth treatment.

 

Jpn. J. Cardiovasc. Surg. 50:301-304（2021）

Keywords：NOMI;lactate;prostaglandin