Early Diagnosis and Therapy of Non-occlusive Mesenteric Ischemia after Open Heart Surgery

(Department of Cardiovascular Surgery, Heart Center, Sendai Kosei Hospital, Sendai, Japan)

Suguru Watanabe Gen-ya Yaginuma Azumi Hamasaki
Shun-ichi Kawarai
Non-occlusive mesenteric ischemia (NOMI) is a rare but often fatal event following cardiac surgery. Early diagnosis of NOMI is difficult because the related abdominal symptoms are not very specific. From April 1999 to September 2003, 1,040 patients underwent cardiac surgery, among whom 5 patients who underwent angiography were given a diagnosis of NOMI. A catheter was used for immediate intra-arterial infusion of 500g prostaglandin E1 into the superior mesenteric artery over a period of 30min, Prior to angiography, all patients had cutis marmorata and elevated serum lactate levels. Three patients showed peritoneal signs and therefore underwent laparotomy. Of the 5 patients, 4 survived. In conclusion, if mesenteric ischemia is suspected, selective angiography must be performed as soon as possible for diagnosis and treatment. Additionally, the presence of other findings such as cutis marmorata and elevated serum lactate levels proved to be useful in the early diagnosis of NOMI.
@Jpn. J. Cardiovasc. Surg. 37: 69-73 (2008)