A Case of Non-Occlusive Mesenteric Ischemia after Off-Pump CABG and Abdominal Aortic Aneurysm Replacement

(Department of Thoracic and Cardiovascular Surgery, Anjo-kosei General Hospital, Anjo, Japan)

Toshiya Tokui Shinji Kanemitsu Keizou Tanaka
Hitoshi Suzuki Toshihiko Kinoshita
Fatal intestinal necrosis developed following off-pump CABG and implantation of a bifurcated vascular prosthesis in a 70-year-old man with unstable angina pectoris and abdominal aortic aneurysm. A CT scan with three-dimensional reconstruction (3D-CT), showed no narrowing or obstruction of the SMA. The patient was scheduled to undergo an extensive resection of the intestine on the 23rd postoperative day. The pathological diagnosis was nonocclusive mesenteric ischemia (NOMI). He died of multiple organ failure on the 38th postoperative day. Early diagnosis of NOMI is essential to lower mortality and postoperative morbidity. Invasive angiography is the gold standard in diagnosis. 3D-CT, a non-invasive method, is an increasingly useful technique, which may allow identification of vascular anatomy and pathology with sufficient detail for diagnosis. Several other causes of acute abdomen, other than mesenteric ischemia, can be ruled out. Therefore, 3D-CT might be useful in screening for NOMI.
@Jpn. J. Cardiovasc. Surg. 34: 386-388 (2005)