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Delayed bowel stenosis following subtotal resection of the small intestine for non-occlusive mesenteric ischemia

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Abstract

We report herein a case of delayed bowel stenosis after surgery for non-occlusive mesenteric ischemia (NOMI), which was successfully treated with endoscopic stenting. The patient was a 78-year-old woman who underwent an emergency laparotomy for NOMI and duodeno-ileal anastomosis. Necrosis was observed in almost all areas of the small intestine except for the beginning of the jejunum and the end of the ileum. Postoperatively, the patient was discharged with central venous nutrition, but was readmitted on postoperative day 54 with a diagnosis of postoperative ileus. The patient failed to respond to conservative treatment. Fluoroscopic endoscopy revealed wall stiffness and circumferential stenosis in the ascending colon at a different site from that of the anastomosis. Based on this finding, delayed stenosis of the ascending colon after NOMI treatment was diagnosed. Bougie dilatation was performed for the stenosis, leading to temporary improvement. However, stenosis along with ileus soon recurred. To prevent restenosis, a metallic stent was endoscopically implanted at the stenotic site. Thereafter, the patient was discharged without any further episodes of restenosis. Delayed bowel stenosis may occur after a subtotal resection of the small intestine for NOMI. Endoscopic stenting is an effective treatment option if resection is difficult.

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Acknowledgements

The authors would like to thank James R. Valera for his assistance with editing this manuscript.

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Authors and Affiliations

  1. Department of Hepato-Biliary-Pancreatic Surgery, Tokyo Metropolitan Cancer and Infectious Diseases Center, Komagome Hospital, 3-18-22 Honkomagome, Bunkyo-Ku, Tokyo, 113-8677, Japan

    Eito Nakagawa, Yasuji Seyama, Mikiya Takao, Keigo Tani & Hiroko Okinaga

  2. Department of Systemic Immunological Disease, Tokyo Metropolitan Cancer and Infectious Diseases Center, Komagome Hospital, 3-18-22 Honkomagome, Bunkyo-Ku, Tokyo, 113-8677, Japan

    Fang Yi Chen

  3. Department of Gastroenterology, Tokyo Metropolitan Cancer and Infectious Diseases Center, Komagome Hospital, 3-18-22 Honkomagome, Bunkyo-Ku, Tokyo, 113-8677, Japan

    Hiroki Tabata, Jun Nakahodo & Kazuro Chiba

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  1. Eito Nakagawa
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  2. Yasuji Seyama
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  3. Mikiya Takao
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  4. Keigo Tani
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  5. Hiroko Okinaga
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  6. Fang Yi Chen
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  7. Hiroki Tabata
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  8. Jun Nakahodo
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  9. Kazuro Chiba
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Correspondence to Yasuji Seyama.

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Nakagawa, E., Seyama, Y., Takao, M. et al. Delayed bowel stenosis following subtotal resection of the small intestine for non-occlusive mesenteric ischemia. Clin J Gastroenterol 17, 276–280 (2024). https://doi.org/10.1007/s12328-023-01898-4

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  • DOI: https://doi.org/10.1007/s12328-023-01898-4

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