Non-inclusive mesenteric ischemia K55.0

Non-occlusive mesenteric ischemia (NOMI) is an underperfusion of the mesenteric stream with reactive vasospasm. It results in varying degrees of involvement of different intestinal segments up to gangrene. NOMI can occur as a complication of any serious disease or surgery.

Risk factors for NOMI are patient-related factors such as:

• age
• Restricted left ventricular pump function
• Peripheral and cerebrovascular vascular diseases
• Renal insufficiency.

Furthermore:

• Chronic Hemodialysis

Cardiosurgical operations with extracorporeal circulation. NOMI manifests itself after about 0.5-1 % of all cardiac surgery operations. Note: It is assumed that a reduction of cardiac output or a perioperative hypotonic phase leads to vasoconstriction of the splanchnicotomy pathway with consecutive intestinal miderperfusion.

The first symptoms of NOMI are usually unspecific abdominal complaints. Since NOMI often occurs in an unstable phase in non-responsive patients, symptoms such as meteorism, constipation and diarrhoea must be included in the differential diagnosis.

If NOMI is suspected, catheter angiography (digital subtraction angiography, DSA) should be performed primarily. The therapy of choice is the selective application of vasodilators into the superior mesenteric artery (addition: PGE1 alprostadil 20 µg as a bolus, then perfusor-controlled 60-80 µg/24h; alternatively: PGI2 ipoprostenol 5-6 ng/kg/min heparin i.v. 20 000 IU/24h).
Thus the generalized vasospasm can be successfully broken. The efficiency of the vasodilatation is checked by control angiography.
A surgical procedure is only necessary in the case of clinical signs of peritonitis or in intubated patients with secondary organ dysfunction and is aimed exclusively at the resection of irreversibly damaged sections of the intestine.

The prognosis of NOMI depends on the extent of the intestinal damage. This makes it necessary to diagnose and treat this clinical picture at an early stage.

1. Amor F et al (2011) Mesenteric panniculitis presenting with acute non-occlusive colonic ischemia. Int Arch Med 4:22.
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3. Quiroga B et al (2013) Detection of patients at high risk for non-occlusive mesenteric ischemia in hemodialysis. J Surg Res 180:51-55.
4. Lock G (2012) Acute mesenteric ischemia. Non-occlusive mesenteric ischemia. In: Messmann H (Ed.) Clinical Gastroenterology. Georg Thieme publishing house Stuttgart p.461
5. Weiss G et al (2012) Successful management of non-occlusive mesenteric ischemia (NOMI) - case report. Pol Przegl Chir 84:214-218.
6. Yu CC et al (2009) Factors associated with mortality from non-occlusive mesenteric ischemia in dialysis patients. Ren Fail 31:802-806.