Diagnosis and Management of Nonocclusive Mesenteric Ischemia

Himani Agarwal; Anil K. Pillai; Sanjeeva P. Kalva

doi:10.1055/s-0038-1668569

Digestive Disease Interventions, Table of Contents

Digestive Disease Interventions 2018; 02(03): 240-243
DOI: 10.1055/s-0038-1668569

Review Article

Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

Diagnosis and Management of Nonocclusive Mesenteric Ischemia

Himani Agarwal

²Department of Clinical Radiology, Scunthorpe General Hospital, Northern Lincolnshire and Goole NHS Trust, Scunthorpe, North Lincolnshire, England, United Kingdom

,

Anil K. Pillai

³Division of Interventional Radiology, Department of Radiology, University of Texas Health Sciences Centre, Houston, Texas

,

Sanjeeva P. Kalva

¹University of Texas Southwestern Medical Center at Dallas, Dallas, Texas

› Author Affiliations

Abstract

Acute hypoperfusion of the bowel without mechanical occlusion of the arterial or venous circulation is referred to as nonocclusive mesenteric ischemia (NOMI) and is responsible for approximately one fourth of all arterial causes of mesenteric ischemia. Patients present with nonspecific symptoms, making clinical diagnosis difficult. Prognosis is poor with high mortality rates. Mortality rates have improved during the past two decades from 80 to 50% due to early diagnosis and prompt initiation of treatment. In this review, we discuss the etiology, pathophysiology, and symptoms of NOMI as well as radiological findings and management along with comprehensive review of the literature.

Keywords

nonocclusive mesenteric ischemia - CT - mesenteric ischemia - bowel ischemia

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References

References
1 Kammerer S, Schuelke C, Berkemeyer S. , et al. The role of multislice computed tomography (MSCT) angiography in the diagnosis and therapy of non-occlusive mesenteric ischemia (NOMI): Could MSCT replace DSA in diagnosis?. PLoS One 2018; 13 (03) e0193698
2 Trompeter M, Brazda T, Remy CT, Vestring T, Reimer P. Non-occlusive mesenteric ischemia: etiology, diagnosis, and interventional therapy. Eur Radiol 2002; 12 (05) 1179-1187
3 Mastoraki A, Mastoraki S, Tziava E. , et al. Mesenteric ischemia: pathogenesis and challenging diagnostic and therapeutic modalities. World J Gastrointest Pathophysiol 2016; 7 (01) 125-130
4 Vokurka J, Olejnik J, Jedlicka V, Vesely M, Ciernik J, Paseka T. Acute mesenteric ischemia. Hepatogastroenterology 55 (85) 1349-1352
5 Mitsuyoshi A, Obama K, Shinkura N, Ito T, Zaima M. Survival in nonocclusive mesenteric ischemia: early diagnosis by multidetector row computed tomography and early treatment with continuous intravenous high-dose prostaglandin E(1). Ann Surg 2007; 246 (02) 229-235
6 Stöckmann H, Roblick UJ, Kluge N. , et al. [Diagnosis and therapy of non-occlusive mesenteric ischemia (NOMI)]. Zentralbl Chir 2000; 125 (02) 144-151
7 Bassiouny HS. Nonocclusive mesenteric ischemia. Surg Clin North Am 1997; 77 (02) 319-326
8 Nakamura Y, Urashima M, Toyota N. , et al. Non-occlusive mesenteric ischemia (NOMI): utility of measuring the diameters of the superior mesenteric artery and superior mesenteric vein at multidetector CT. Jpn J Radiol 2013; 31 (11) 737-743
9 Woodhams R, Nishimaki H, Fujii K, Kakita S, Hayakawa K. Usefulness of multidetector-row CT (MDCT) for the diagnosis of non-occlusive mesenteric ischemia (NOMI): assessment of morphology and diameter of the superior mesenteric artery (SMA) on multi-planar reconstructed (MPR) images. Eur J Radiol 2010; 76 (01) 96-102
10 Kamimura K, Oosaki A, Sugahara S, Mori S. Survival of three nonocclusive mesenteric ischemia patients following early diagnosis by multidetector row computed tomography and prostaglandin E1 treatment. Intern Med 2008; 47 (22) 2001-2006
11 Björck M, Wanhainen A. Nonocclusive mesenteric hypoperfusion syndromes: recognition and treatment. Semin Vasc Surg 2010; 23 (01) 54-64
12 Siegelman SS, Sprayregen S, Boley SJ. Angiographic diagnosis of mesenteric arterial vasoconstriction. Radiology 1974; 112 (03) 533-542
13 Versyck G, de Gheldere C, Vanclooster P. Non-occlusive mesenteric ischemia: two case reports and a short review of the literature. Acta Chir Belg 2017; ;(November): 1-6
14 Minko P, Groesdonk H, Stroeder J. , et al. A scoring system for the assessment of angiographic findings in non-occlusive mesenteric ischemia (NOMI). RoFo Fortschr Geb Rontgenstr Nuklearmed 2012; 184 (09) 805-809
15 Bomberg H, Groesdonk HV, Raffel M. , et al. Vasopressin as therapy during nonocclusive mesenteric ischemia. Ann Thorac Surg 2016; 102 (03) 813-819
16 Boley SJ, Sprayregan S, Siegelman SS, Veith FJ. Initial results from an agressive roentgenological and surgical approach to acute mesenteric ischemia. Surgery 1977; 82 (06) 848-855
17 Kozuch PL, Brandt LJ. Review article: diagnosis and management of mesenteric ischaemia with an emphasis on pharmacotherapy. Aliment Pharmacol Ther 2005; 21 (03) 201-215
18 Bulkley GB, Zuidema GD, Hamilton SR, O'Mara CS, Klacsmann PG, Horn SD. Intraoperative determination of small intestinal viability following ischemic injury: a prospective, controlled trial of two adjuvant methods (Doppler and fluorescein) compared with standard clinical judgment. Ann Surg 1981; 193 (05) 628-637
19 Ishizuka M, Nagata H, Takagi K. , et al. Usefulness of intraoperative observation using a fluorescence imaging instrument for patients with nonocclusive mesenteric ischemia. Int Surg 2015; 100 (04) 593-599