Advertisement

Management and Results

  • T. R. van Oudheusden
  • M. Dekkers
  • A. S. Bode
  • J. A. Teijink
  • M. D. LuyerEmail author
Chapter

Abstract

NOMI is a severe disease associated with a mortality rate of 70 %. In order to achieve the best result, a timely diagnosis is of the utmost importance. Besides general treatment of mesenteric ischemia, treatment should be focused on relieving the vasospasm to return adequate blood flow to the splanchnic circulation. Treatment with intra-arterial papaverine can successfully relieve mesenteric vasoconstriction, although mesenteric angiography may not be possible due to an unfavorable patient presentation. A good alternative is the application of a high dose of intravenous PGE1. Surgical intervention should be reserved for patients in whom initial treatment fails.

Keywords

NOMI Intestinal ischemia Papaverine PGE1 Management of mesenteric ischemia Nonocclusive mesenteric ischemia 

References

  1. 1.
    Sise MJ. Mesenteric ischemia: the whole spectrum. Scand J Surg. 2010;99(2):106–10. PubMed PMID: 20679047.PubMedGoogle Scholar
  2. 2.
    Oldenburg WA, Lau LL, Rodenberg TJ, Edmonds HJ, Burger CD. Acute mesenteric ischemia: a clinical review. Arch Intern Med. 2004;164(10):1054–62. PubMed PMID: 15159262.PubMedCrossRefGoogle Scholar
  3. 3.
    Schoots IG, Koffeman GI, Legemate DA, Levi M, van Gulik TM. Systematic review of survival after acute mesenteric ischaemia according to disease aetiology. Br J Surg. 2004;91(1):17–27. PubMed PMID: 14716789.PubMedCrossRefGoogle Scholar
  4. 4.
    Boley SJ, Sprayregan S, Siegelman SS, Veith FJ. Initial results from an aggressive roentgenological and surgical approach to acute mesenteric ischemia. Surgery. 1977;82(6):848–55. PubMed PMID: 929375.PubMedGoogle Scholar
  5. 5.
    Trompeter M, Brazda T, Remy CT, Vestring T, Reimer P. Non-occlusive mesenteric ischemia: etiology, diagnosis, and interventional therapy. Eur Radiol. 2002;12(5):1179–87. PubMed PMID: 11976865.PubMedCrossRefGoogle Scholar
  6. 6.
    Gewertz BL, Zarins CK. Postoperative vasospasm after antegrade mesenteric revascularization: a report of three cases. J Vasc Surg. 1991;14(3):382–5. PubMed PMID: 1880846.PubMedCrossRefGoogle Scholar
  7. 7.
    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(2):229–35. PubMed PMID: 17667501. Pubmed Central PMCID: 1933563.PubMedCentralPubMedCrossRefGoogle Scholar
  8. 8.
    Tabriziani H, Frishman WH, Brandt LJ. Drug therapies for mesenteric vascular disease. Heart Dis. 2002;4(5):306–14. PubMed PMID: 12350243.PubMedCrossRefGoogle Scholar
  9. 9.
    Bozlar U, Turba UC, Hagspiel KD. Nonocclusive mesenteric ischemia: findings at multidetector CT angiography. J Vasc Interv Radiol. 2007;18(10):1331–3. PubMed PMID: 17911529.PubMedCrossRefGoogle Scholar
  10. 10.
    Wyers MC. Acute mesenteric ischemia: diagnostic approach and surgical treatment. Semin Vasc Surg. 2010;23(1):9–20. PubMed PMID: 20298945.PubMedCrossRefGoogle Scholar
  11. 11.
    Cawello W, Schweer H, Muller R, Bonn R, Seyberth HW. Metabolism and pharmacokinetics of prostaglandin E1 administered by intravenous infusion in human subjects. Eur J Clin Pharmacol. 1994;46(3):275–7. PubMed PMID: 8070511.PubMedCrossRefGoogle Scholar
  12. 12.
    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):2001–6. PubMed PMID: 19015617.PubMedCrossRefGoogle Scholar
  13. 13.
    Kazmers A. Operative management of chronic mesenteric ischemia. Ann Vasc Surg. 1998;12(3):299–308. PubMed PMID: 9588521.PubMedCrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media New York 2015

Authors and Affiliations

  • T. R. van Oudheusden
    • 1
  • M. Dekkers
    • 1
  • A. S. Bode
    • 1
  • J. A. Teijink
    • 1
  • M. D. Luyer
    • 1
    Email author
  1. 1.Department of SurgeryCatharina Hospital EindhovenEindhovenThe Netherlands

Personalised recommendations