Nonocclusive mesenteric ischemia: fulminant pancolitis

Abstract

NOMI is mesenteric hypoperfusion with reactive vascular spasms. Changes in the color of the mucosa may reflect the severity of the ischemia of the colon and the severity of prognosis. Even with surgery, the mortality rate is 75%. Diagnosis requires a high degree of clinical suspicion.

Keywords: Acute mesenteric ischemia; colonoscopy; computed tomography angiography; fulminant pancolitis; nonocclusive mesenteric ischemia.

Figure 1

(A) A plain abdominal X‐ray showed air‐filled and dilated colon loops as the sign of paralytic ileus. (B) Abdominal noncontrast computed tomography (CT) scan showed intestinal segments dilated and distended by air‐fluid levels, resulting in paralytic ileus and diffusely involving small bowel loops with pneumatosis intestinalis (arrow). (C) The colonoscopic examination revealed a focal area of pale and edematous mucosa interspersed with petechial hemorrhage and superficial ulceration on the recto‐sigmoid colon. (D) A reformat CT image showed a reduced number of vessels in the mesentery of the bowel loops.

Figure 2

(A, B, C) The colonoscopic examination revealed an edematous mucosa interspersed with petechial hemorrhage and superficial ulceration on the recto‐sigmoid colon and a gray‐green to black mucosa on the transverse colon and descending colon. (D) Multiple biopsies showed mucosal necrosis, submucosal hemorrhage, congestion of the submucosa, and inflammatory infiltration in the lamina propria (×100).