| [ Summary ] |
Nonocclusive mesenteric ischemia (NOMI) is an intra-abdominal catastrophe related to bowel necrosis in the absence of organic mesenteric vascular occlusions. Mesenteric vasospasms are a cause of NOMI, which may be induced by excessive sympathetic activity with cardiogenic, hypovolemic shock, digitalis toxicity, or common factors which decrease cardiac output with splanchnic vasoconstriction. Because physical, roentgenographic findings, and laboratory tests are not specific enough until after intestinal infarction has occurred, it is difficult to make an early diagnosis of NOMI, producing high mortlity rates. Early arteriography in patients suspected of having NOMI offers a chance for early diagnosis and pharmacological treatment prior to the onset of intestinal infarction. If the peritoneal signs fail to resolve with pharmacological treatment, immediate laparotomy is indicated. The aim of this operation is to assess bowel viability, resect obviously infracted bowel segments, and determine whether a second operation after twenty four hours is necessary. The purpose of this article is to summarize the pathophysiology, diagnosis and treatment modalities for NOMI and present case reports. |