scholarly journals A Case of Septicemia due to Nonocclusive Mesenteric Ischemia Occurring in Induction Chemotherapy

2018 ◽  
Vol 2018 ◽  
pp. 1-4
Author(s):  
Hideki Tanaka ◽  
Kiyoaki Tsukahara ◽  
Isaku Okamoto ◽  
Rio Kojima ◽  
Kazuhiro Hirasawa ◽  
...  
Keyword(s):  
Mesenteric Ischemia ◽  
Abdominal Distension ◽  
Oropharyngeal Carcinoma ◽  
Continuous Hemodiafiltration ◽  
Nonocclusive Mesenteric Ischemia ◽  
Intestinal Necrosis ◽  
Neck Tumors ◽  
Contrast Enhanced ◽  
Serious Disease ◽  
Enhanced Computed Tomography

In nonocclusive mesenteric ischemia (NOMI), mesenteric ischemia and intestinal necrosis occur despite the absence of organic blockage in mesenteric blood vessels. As abdominal pain is often absent and few characteristic findings are seen in blood biochemistry, imaging diagnosis or other examinations, discovery is often delayed. With a mortality rate of 56–79%, NOMI is a very serious disease. However, few reports have described this pathology in association with chemotherapy regimens such as those used for malignant head and neck tumors. We encountered a case of NOMI during induction therapy combining cisplatin, docetaxel, and 5-fluorouracil. The patient was a 74-year-old man receiving chemotherapy for T2N2bM0 stage IVA oropharyngeal carcinoma. Febrile neutropenia appeared on treatment day 8. An antibacterial agent and a granulocyte colony-stimulating factor were administered, but septic shock developed and he was transferred to the intensive care unit. Abdominal distension was present and contrast-enhanced computed tomography of the abdomen suggested NOMI. Emergency surgery on day 9 resected the necrotized small intestine and created a single-hole ileostomy. The patient subsequently recovered with 2 weeks of continuous hemodiafiltration and other intensive therapies. Otolaryngological surgeons seldom encounter intestinal diseases, which are thus easily overlooked. The present case report may help in achieving early diagnosis.

scholarly journals Nonocclusive mesenteric ischemia associated with postoperative jejunal tube feeding: Indicators for clinical management

2020 ◽  
Vol 48 (8) ◽  
pp. 030006052092912
Author(s):  
Hendrik Christian Albrecht ◽  
Mateusz Trawa ◽  
Stephan Gretschel
Keyword(s):  
Small Bowel ◽  
Mesenteric Ischemia ◽  
Clinical Symptoms ◽  
Treatment Guideline ◽  
Tube Feeding ◽  
Pneumatosis Intestinalis ◽  
Abdominal Distension ◽  
Bowel Necrosis ◽  
Nonocclusive Mesenteric Ischemia ◽  
Jejunal Tube

Postoperative nutrition via a jejunal tube after major abdominal surgery is usually well tolerated. However, some patients develop nonocclusive mesenteric ischemia (NOMI). This morbid complication has a grave prognosis with a mortality rate of 41% to 100%. Early symptoms are nonspecific, and no treatment guideline is available. We reviewed cases of NOMI at our institution and cases described in the literature to identify factors that impact the clinical course. Among five patients, three had no necrosis and one had segmental necrosis and perforation. These patients recovered with limited resection and decompression of the bowel and abdominal compartment. In one patient with extended bowel necrosis at the time of re-laparotomy, NOMI progressed and the patient died of multiple organ failure. The extent of small bowel necrosis at the time of re-laparotomy is a relevant prognostic factor. Therefore, early diagnosis and treatment of NOMI can improve the prognosis. Clinical symptoms of abdominal distension, cramps and high reflux plus paraclinical signs of leukocytosis, hypotension and computed tomography findings of a distended small bowel with pneumatosis intestinalis and portal venous gas can help to establish the diagnosis. We herein introduce an algorithm for the diagnosis and management of NOMI associated with jejunal tube feeding.

Evaluating the Risk of Irreversible Intestinal Necrosis Among Critically Ill Patients With Nonocclusive Mesenteric Ischemia

2021 ◽  
Vol Publish Ahead of Print ◽  
Author(s):  
Paul Calame ◽  
Hadrien Winiszewski ◽  
Alexandre Doussot ◽  
Alexandre Malakhia ◽  
Franck Grillet ◽  
...  
Keyword(s):  
Critically Ill ◽  
Critically Ill Patients ◽  
Mesenteric Ischemia ◽  
Nonocclusive Mesenteric Ischemia ◽  
Intestinal Necrosis

scholarly journals Nonocclusive Mesenteric Ischemia Associated with Ogilvie Syndrome

2014 ◽  
Vol 2014 ◽  
pp. 1-4 ◽  
Author(s):  
Takashi Sakamoto ◽  
Toshiyuki Suganuma ◽  
Shinichiro Okada ◽  
Kensuke Nakatani ◽  
Sawako Tamaki ◽  
...  
Keyword(s):  
Small Bowel ◽  
Mesenteric Ischemia ◽  
Colonic Obstruction ◽  
Acute Mesenteric Ischemia ◽  
Pneumatosis Intestinalis ◽  
Abdominal Distension ◽  
Emergency Laparotomy ◽  
Nonocclusive Mesenteric Ischemia ◽  
Ischemic Bowel ◽  
Ogilvie Syndrome

Nonocclusive mesenteric ischemia (NOMI) is one type of acute mesenteric ischemia. Colonic pseudoobstruction, known as Ogilvie syndrome, is a disorder defined by colonic distension in the absence of mechanical obstruction. A relationship between these diseases has not yet been reported, based on a review of the literature. We report a patient with NOMI secondary to Ogilvie syndrome. An 82-year-old woman reported three days of intermittent abdominal pain. Plain computed tomography scan showed colonic obstruction at the rectosigmoid colon. Colonoscopy was performed that showed a large amount of stool and no evidence of tumor or other physical causes of obstruction. We diagnosed the patient with Ogilvie syndrome and continued nonoperative management. On the third hospital day, she complained of abdominal distension. A repeat CT scan showed pneumatosis intestinalis in the small bowel and ascending colon, with portal venous gas. Emergency laparotomy was performed with diagnosis of mesenteric ischemia. Intraoperatively, there were multiple skip ischemic lesions in the small intestine and cecum. We resected the ischemic bowel and performed a distal jejunostomy. Her residual small bowel measured just 20 cm in length. Postoperatively, her general status gradually improved. She was discharged with total parenteral nutrition and a small amount of enteral nutrition.

scholarly journals An Unusual Presentation of T-Cell Lymphoblastic Lymphoma with Isolated Renal Involvement

2019 ◽  
Vol 2019 ◽  
pp. 1-3
Author(s):  
Sultan Aydın Köker ◽  
Alper Koker ◽  
Adem Yasin Köksoy ◽  
Yasemin Kayadibi ◽  
Ülkü Gül Şiraz ◽  
...  
Keyword(s):  
T Cell ◽  
Renal Involvement ◽  
Pediatric Nephrology ◽  
Abdominal Distension ◽  
Lymphoblastic Lymphoma ◽  
Abdominal Ultrasonography ◽  
Non Hodgkin Lymphoma ◽  
Contrast Enhanced ◽  
Renal Enlargement ◽  
Enhanced Computed Tomography

The clinical presentation of Non-Hodgkin lymphoma (NHL) is frequently associated with the involvement of the abdomen and mediastinal lymphadenopathies, but rarely the kidney, ovaries, and testicles. Here, we report a rare case of T-cell lymphoblastic lymphoma (T-LBL) presenting with bilateral nephromegaly without acute renal failure (ARF) as the first manifestation. A 30-month-old boy was admitted to the department of pediatric nephrology exhibiting abdominal distension. Physical examination revealed bilateral renal palpation up to the inguinal region. Elevated lactate dehydrogenase (LDH) levels were detected in his blood. Bilateral diffuse enlarged kidneys with increased hypoechogenicity were found on abdominal ultrasonography. In the next step, contrast-enhanced computed tomography showed diffusely enlarged kidneys, which were compressing the intestinal bowels and midline structures. Renal biopsy demonstrated precursor T-LBL. We wish to report our patient with renal T-LBL presenting with diffuse renal enlargement, which has rarely been reported in the literature.

scholarly journals LEFT PARADUODENAL HERNIA AS A RARE CAUSE OF INTESTINAL OBSTRUCTION-LAPAROSCOPIC MANAGEMENT

2020 ◽  
pp. 1-2
Author(s):  
Bhavesh Shelke ◽  
Abhijit Joshi
Keyword(s):  
Intestinal Obstruction ◽  
Laparoscopic Approach ◽  
Emergency Situation ◽  
Abdominal Distension ◽  
Paraduodenal Hernia ◽  
Contrast Enhanced ◽  
Colicky Pain ◽  
Enhanced Computed Tomography ◽  
Upper Abdomen ◽  
Contrast Enhanced Computed Tomography

We report a case of 33 years old male, presented with colicky pain in left upper abdomen on and off since 15 days, one episode of bilious vomiting and abdominal distension with constipation since 2 days. A case of intestinal obstruction was diagnosed as a Left Paraduodenal Hernia[PDH] on contrast enhanced computed tomography of the abdomen(CECT) and managed with laparoscopic repair. Through this case report, we want to give the message that PDH though rare should be considered as a differential diagnosis in a case of intestinal obstruction and can be managed successfully with laparoscopic approach even in an emergency situation.

scholarly journals Imaging findings in Fetus-in-fetu-misdiagnosed commonly as teratoma

2021 ◽  
Vol 8 (11) ◽  
pp. 1905
Author(s):  
Rajakumar R. ◽  
Annu Singhal ◽  
Sana Sana ◽  
Kavita Vani
Keyword(s):  
Rare Condition ◽  
Abdominal Distension ◽  
Malignant Potential ◽  
The Body ◽  
Retroperitoneal Mass ◽  
Girl Child ◽  
Fetus In Fetu ◽  
Contrast Enhanced ◽  
Enhanced Computed Tomography ◽  
Contrast Enhanced Computed Tomography

Fetus in fetu is a rare condition associated with abnormal embryogenesis in a diamniotic, monochorionic pregnancy, wherein one of the fetus is enclosed within the body of another normally developing fetus. It should be differentiated from a teratoma because of the later’s malignant potential. Here we report a case of 2 months old girl child who presented with complaints of abdominal distension. USG showed a solid cystic retroperitoneal mass resembling an anencephalic fetus. Contrast enhanced Computed tomography (CT) showed similar findings with visualization of bones resembling femur, sacrum and vertebrae. Findings were correlated with MRI and post-op pathology. The preoperative diagnosis of FIF is based on the observation of vertebral column or limbs in a mass on imaging modalities and our case meets the required criteria.

The Pathogenesis of Nonocclusive Mesenteric Ischemia: Implications for Research and Clinical Practice

2018 ◽  
Vol 34 (10) ◽  
pp. 771-781 ◽  
Author(s):  
Hussam Al-Diery ◽  
Anthony Phillips ◽  
Nicholas Evennett ◽  
Sanjay Pandanaboyana ◽  
Michael Gilham ◽  
...  
Keyword(s):  
Mesenteric Ischemia ◽  
Delayed Diagnosis ◽  
Acute Mesenteric Ischemia ◽  
Ct Scanning ◽  
Abdominal Distension ◽  
Major Surgery ◽  
Future Research ◽  
Abdominal Pressure ◽  
Unexpected Finding ◽  
Nonocclusive Mesenteric Ischemia

Nonocclusive mesenteric ischemia (NOMI) is a condition that can encompass ischemia, inflammation, and infarction of the intestinal wall. In contrast to most patients with acute mesenteric ischemia, NOMI is distinguished by patent arteries and veins. The clinical presentation of NOMI is often insidious and nonspecific, resulting in a delayed diagnosis. Patients most at risk are those with severe acute and critical disease, including major surgery and trauma. Nonocclusive mesenteric ischemia is part of a spectrum, from mild, asymptomatic, and an unexpected finding on CT scanning, through to those exhibiting abdominal distension and peritonitis. Severe NOMI is associated with a significant mortality rate. This review of NOMI pathophysiology was conducted to document current concepts and evidence, to examine the implications for diagnosis and treatment, and to identify gaps in knowledge that might direct future research. The key pathologic mechanisms involved in the genesis of NOMI represent an exaggerated normal physiological response to maintain perfusion of vital organs at the expense of mesenteric perfusion. A supply–demand mismatch develops in the intestine due to the development of persistent mesenteric vasoconstriction resulting in reduced blood flow and oxygen delivery to the intestine, particularly to the vulnerable superficial mucosa. This mismatch can be exacerbated by raised intra-abdominal pressure, enteral nutrition, and the use of certain vasoactive drugs, ultimately resulting in the development of intestinal ischemia. Strategies for prevention, early detection, and treatment are urgently needed.

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