Surgery Book

Stomach Disorders

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Nonocclusive Mesenteric Ischemia

Aka: Nonocclusive Mesenteric Ischemia, NOMI
  1. See Also
    1. Mesenteric Ischemia
  2. Epidemiology
    1. Accounts for 20-30% of Acute Mesenteric Ischemia
    2. Age: 70 years is mean age
  3. Pathophysiology
    1. Decreased perfusion to splenic flexure and distal sigmoid colon (watershed areas)
    2. Results from hypoperfusion or shock state
      1. Low Cardiac Output (shock)
      2. Mesenteric arterial Vasoconstriction (severe and prolonged)
  4. Causes
    1. Septic Shock
    2. Myocardial Infarction or Myocardial Ischemia
    3. Congestive Heart Failure exacerbation
    4. Hypovolemia
    5. Vascular compression from intraabdominal compression
    6. Bowel Obstruction with Strangulation
      1. Internal Hernia or closed loop obstruction
      2. Volvulus
  5. Risk Factors
    1. Hospitalized patients
    2. Post-Surgical status
    3. Hemodialysis
    4. Medications
      1. Vasopressors
      2. Digitalis
  6. Symptoms
    1. Gradual onset of symptoms over days in Nonocclusive Mesenteric Ischemia
      1. Contrast with sudden symptom onset of acute mesenteric Occlusion
    2. Abdominal Pain is absent in 25% of cases
  7. Signs
    1. Bleeding per Rectum is common (occult or grossly bloody stools)
  8. Imaging
    1. Abdominal CT or Abdominal MRI
      1. Bowel ischemia may be present
    2. Colonoscopy with biopsy (gold standard)
    3. Angiography
      1. May show arterial narrowing
    4. Abdominal Xray
      1. Listed for historical reasons only (all other advanced imaging is preferred)
      2. Early: Mild bowel dilation
      3. Late: Thumb printing, pneumatosis, portal venous gas
  9. Management
    1. See Mesenteric Ischemia
    2. Supportive care is paramount
      1. Fluid Resuscitation to reverse hemodynamic instability
      2. Avoid Vasopressors
      3. Avoid Vasoconstricting agents
    3. Bowel infarction
      1. Anticoagulation or antiplatelet agents
      2. Vasodilation
        1. Targeted Papaverine infusion via angiography (Intervention Radiology)
          1. Risk of Hypotension if catheter migrates into aorta
      3. Surgery is only indicated if peritoneal signs are present
  10. Prognosis: Outcomes
    1. Overall mortality is >50%
    2. Reversible ischemia in 44% of cases
    3. Persistent colitis in 19% of cases
    4. Ischemic stricture in 13% of cases
    5. Perforation or gangrene in 19% of cases
  11. References
    1. Fraboni (2012) Board Review Express, San Jose
    2. Kern and Gilley-Avramis (2022) Crit Dec Emerg Med 36(11) 21-8
    3. Mastoraki (2021) World J Gastrointest Pathophysiol 7(1): 125-30 [PubMed]

Non-occlusive mesenteric ischemia (C0341422)

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
Sources
Derived from the NIH UMLS (Unified Medical Language System)


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