II. Epidemiology
- Accounts for 20-30% of Acute Mesenteric Ischemia
- Age: 70 years is mean age
III. Pathophysiology
- Decreased perfusion to splenic flexure and distal sigmoid colon (watershed areas)
IV. Risk Factors
- More common in hospitalized patients
- Hypoperfusion due to Hypotension or shock state
- Sepsis
- Hemorrhagic blood loss
- Cardiogenic Shock
- Congestive Heart Failure exacerbation
- Myocardial Infarction or Myocardial Ischemia
- Post-Surgical status
- Dialysis
- Medications
- Pressor use
- Digitalis
V. Symptoms
- Gradual onset of symptoms over days in Nonocclusive Mesenteric Ischemia
- Contrast with sudden symptom onset of acute mesenteric Occlusion
- Abdominal Pain is absent in 25% of cases
VI. Signs
- Bleeding per Rectum is common (occult or grossly bloody stools)
VII. Imaging
- Abdominal Xray
- Early: Mild bowel dilation
- Late: Thumb printing, pneumatosis, portal venous gas
-
Abdominal CT or Abdominal MRI
- Bowel ischemia may be present
- Colonoscopy with biopsy (gold standard)
- Angiography
- May show arterial narrowing
VIII. Management
- Papaverine infusion
- Consider Antiplatelet Therapy
- Surgery is only indicated if peritoneal signs are present
IX. Prognosis: Outcomes
- Reversible ischemia in 44% of cases
- Persistent colitis in 19% of cases
- Ischemic stricture in 13% of cases
- Perforation or gangrene in 19% of cases
X. References
- Fraboni (2012) Board Review Express, San Jose
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| Concepts | Disease or Syndrome (T047) |
| SnomedCT | 235843005 |
| English | Non-occl mesenteric ischaemia, Non-occl mesenteric ischemia, NOMI - Non-occl mesent ischaem, Non-occlusive mesenteric ischaemia, Non-occlusive mesenteric ischemia, NOMI - Non-occlusive mesenteric ischaemia, NOMI - Non-occlusive mesenteric ischemia, Non-occlusive mesenteric ischemia (disorder) |
| Spanish | isquemia mesentérica no oclusiva (trastorno), isquemia mesentérica no oclusiva |
