Survival in nonocclusive mesenteric ischemia: early diagnosis by multidetector row computed tomography and early treatment with continuous intravenous high-dose prostaglandin E(1)

Abstract

Objectives: The aim of the study was to establish a procedure for early diagnosis and treatment of nonocclusive mesenteric ischemia (NOMI).

Background: NOMI has a high mortality rate, and early diagnosis and treatment are important for improving survival in patients with this condition.

Methods: The subjects were 22 patients treated at our hospital over 13 years. Diagnostic criteria for NOMI were established based on the first 13 cases. In the 9 more recent cases, we performed abdominal contrast multidetector row computed tomography (MDCT) upon suspicion of NOMI based on these criteria. Imaging allowed definite diagnosis of NOMI, and continuous intravenous high-dose PGE1 administration was initiated immediately after diagnosis (dose, 0.01-0.03 microg/kg per min; mean administration period, 4.8 days).

Results: Nine of the first 13 patients died of multiple organ failure associated with multiple intestinal necrosis. These cases suggested that NOMI may develop when 3 of the following 4 criteria are met after cardiovascular surgery or maintenance dialysis in elderly patients: symptoms of the ileus develop slowly from abdominal symptoms, such as an unpleasant abdominal feeling or pain; a requirement for catecholamine treatment; an episode of hypotension; and slow elevation of the serum transaminase level. In the 9 recent cases, definite diagnosis was made from spasm of the principal arteries in arterial volume rendering and curved planar reformation MDCT images. Early treatment with PGE1 prevented acute-stage NOMI in 8 of the 9 cases.

Conclusions: Early diagnosis of NOMI is possible using the above criteria and MDCT, and initiation of PGE1 treatment may increase survival in patients with NOMI.

FIGURE 1. Images on admission for case P6: (left) VR image from MDCT; and (right) CPR image. Spasm led to narrowing of the superior mesenteric artery in a peripheral area 5 cm from the root of the artery; however, blood flow to the intestinal marginal artery was observed.

FIGURE 2. Images on hospital day 5 for case P6: (left) VR image from MDCT; and (right) CPR image. Spasm and narrowing of the superior mesenteric artery had completely disappeared and the artery had returned to normal.

FIGURE 3. NOMI diagnosis and treatment plan in our hospital.