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Nonocclusive Mesenteric Ischemia
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Nonocclusive Mesenteric Ischemia
, NOMI
See Also
Mesenteric Ischemia
Epidemiology
Accounts for 20-30% of
Acute Mesenteric Ischemia
Age: 70 years is mean age
Pathophysiology
Decreased perfusion to splenic flexure and distal sigmoid colon (watershed areas)
Results from hypoperfusion or shock state
Low
Cardiac Output
(shock)
Mesenteric arterial
Vasocon
striction (severe and prolonged)
Causes
Septic Shock
Myocardial Infarction
or
Myocardial Ischemia
Congestive Heart Failure
exacerbation
Hypovolemia
Vascular compression from intraabdominal compression
Bowel Obstruction
with
Strangulation
Internal Hernia
or closed loop obstruction
Volvulus
Risk Factors
Hospitalized patients
Post-Surgical status
Hemodialysis
Medications
Vasopressor
s
Digitalis
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
Signs
Bleeding per
Rectum
is common (occult or grossly bloody stools)
Imaging
Abdominal CT
or Abdominal MRI
Bowel
ischemia may be present
Colonoscopy
with biopsy (gold standard)
Angiography
May show arterial narrowing
Abdominal Xray
Listed for historical reasons only (all other advanced imaging is preferred)
Early: Mild bowel dilation
Late: Thumb printing, pneumatosis, portal venous gas
Management
Targeted Papaverine infusion via angiography
Risk of
Hypotension
if catheter migrates into aorta
Consider
Antiplatelet Therapy
Surgery is only indicated if peritoneal signs are present
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
References
Fraboni (2012) Board Review Express, San Jose
Mastoraki (2021) World J Gastrointest Pathophysiol 7(1): 125-30 [PubMed]
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