J Korean Soc Traumatol.  2014 Dec;27(4):204-207. 10.0000/jti.2014.27.4.204.

Non-occlusive Mesenteric Ischemia (NOMI) Secondary to Traumatic Hemorrhagic Shock: Case Report

• Lim KH
• Jung HK
• Cho J
• Lee SC
• Park J

• KMID: 2297774
• DOI: http://doi.org/10.0000/jti.2014.27.4.204

Abstract

Non-occlusive mesenteric ischemia (NOMI) encompasses all forms of mesenteric ischemia with patent mesenteric arteries. NOMI is commonly caused by decreased cardiac output resulting in hypoperfusion of peripheral mesenteric arteries. We report a case of NOMI secondary to hemorrhagic shock and rhabdomyolysis due to trauma. A 42-year-old man presented to our trauma center following a pedestrian trauma. On arrival, he was drowsy and in a state of hemorrhagic shock. He was found to have multiple fractures, both lung contusion and urethral rupture. An initial physical examination and abdominal computed tomography (CT) scan revealed no evidence of intra-abdominal injury. High doses of catecholamine were administered for initial 3 days due to unstable vital sign. On day 25 of hospitalization, follow-up abdominal CT scan demonstrated that short segment of small bowel loop was dilated and bowel wall was not enhanced. During exploratory laparotomy, necrosis of the terminal ileum with intact mesentery was detected and ileocecectomy was performed. His postoperative course was uneventful and is under rehabilitation.

Keyword

Non-occlusive mesenteric ischemia; Trauma; Hemorrhagic shock

MeSH Terms

Adult
Cardiac Output
Contusions
Follow-Up Studies
Hospitalization
Humans
Ileum
Ischemia*
Laparotomy
Lung
Mesenteric Arteries
Mesentery
Necrosis
Physical Examination
Rehabilitation
Rhabdomyolysis
Rupture
Shock, Hemorrhagic*
Tomography, X-Ray Computed
Trauma Centers
Vital Signs