Survival in Nonocclusive Mesenteric Ischemia: Early Diagnosis by Multidetector Row Computed Tomography and Early Treatment With Continuous Intravenous High-dose Prostaglandin E1
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In Brief Objectives: The aim of the study was to establish a procedure for early diagnosis and treatment of nonocclusive mesenteric ischemia (NOMI). Background: NOMI has a high mortality rate, and early diagnosis and treatment are important for improving survival in patients with this condition. Methods: The subjects were 22 patients treated at our hospital over 13 years. Diagnostic criteria for NOMI were established based on the first 13 cases. In the 9 more recent cases, we performed abdominal contrast multidetector row computed tomography (MDCT) upon suspicion of NOMI based on these criteria. Imaging allowed definite diagnosis of NOMI, and continuous intravenous high-dose PGE1 administration was initiated immediately after diagnosis (dose, 0.01–0.03 μg/kg per min; mean administration period, 4.8 days). Results: Nine of the first 13 patients died of multiple organ failure associated with multiple intestinal necrosis. These cases suggested that NOMI may develop when 3 of the following 4 criteria are met after cardiovascular surgery or maintenance dialysis in elderly patients: symptoms of the ileus develop slowly from abdominal symptoms, such as an unpleasant abdominal feeling or pain; a requirement for catecholamine treatment; an episode of hypotension; and slow elevation of the serum transaminase level. In the 9 recent cases, definite diagnosis was made from spasm of the principal arteries in arterial volume rendering and curved planar reformation MDCT images. Early treatment with PGE1 prevented acute-stage NOMI in 8 of the 9 cases. Conclusions: Early diagnosis of NOMI is possible using the above criteria and MDCT, and initiation of PGE1 treatment may increase survival in patients with NOMI. Nonocclusive mesenteric ischemia (NOMI) has a high mortality rate, and early diagnosis and treatment are important for improving survival. Upon suspicion of NOMI, based on criteria reported here, diagnosis using abdominal contrast multidetector row computed tomography and immediate initiation of continuous intravenous high-dose prostaglandin E1 administration may increase survival in NOMI patients.
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Continuous intravenous infusion of prostaglandin E1 has shown promise in improving mortality rates in patients with early signs of nonocclusive mesenteric ischemia.
“Continuous intravenous infusion of prostaglandin E1 has also shown promise in improving mortality rates in patients with early signs of nonocclusive mesenteric ischemia [12,34].”
From Revascularization Strategies for Acute and Chronic Mesenteric Ischemia: A Narrative Review (2024) · cites this paper as [34]
The main principle of management of NOMI is reversal of mesenteric arterial spasm and restoration of mesenteric blood flow as fast as possible.
“The main principle of management of NOMI is reversal of mesenteric arterial spasm and restoration of mesenteric blood flow as fast as possible[99].”
From Ischemic bowel disease in 2021. (2021) · cites this paper as [99]
Despite several clinical guidelines mentioning vasodilator therapy for NOMI, only a few small studies have been published.
“Despite several clinical guidelines mentioning vasodilator therapy for NOMI [133–135], only a few small studies have been published [136, 137].”
From Acute mesenteric ischemia: updated guidelines of the World Society of Emergency Surgery. (2022) · cites this paper as [136]
Early treatment with continuous IV prostaglandin E1 (PGE1) reduced mortality in patients with NOMI.
“Another study demonstrated that early treatment with continuous IV prostaglandin E1 (PGE1) reduced mortality in patients with NOMI [136].”
From Acute mesenteric ischemia: updated guidelines of the World Society of Emergency Surgery. (2022) · cites this paper as [136]
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- Authors
- Mitsuyoshi, A., Obama, K., Shinkura, N., Ito, T., & Zaima, M.
- Affiliations
- Mitsubishi Kyoto Hospital (JP)
- Shiga Medical Center for Adults (JP)
- Corresponding author
- Mitsuyoshi, Akira
- Obama, Kazutaka
- Shinkura, Nobuhiko
- Ito, Takashi
- Venue
- Annals of Surgery
- Published
- 2007-08
- Volume
- 246
- Issue
- 2
- Pages
- 229-235
- ISSN
- 0003-4932 (ISSN-L)
- PMC
- PMC1933563
- OpenAlex
- W2024216568
- Cited by
- 202
- References
- 10
- Citations by year
- 2026: 5 · 2025: 6 · 2024: 12 · 2023: 8 · 2022: 11 · 2021: 17 · 2020: 9 · 2019: 9 · 2018: 13 · 2017: 16 · 2016: 13 · 2015: 15 · 2014: 15 · 2013: 11 · 2012: 12
- FWCI
- 6.99
- Type
- journal article
- Language
- en
- Open access
- green
- www.ncbi.nlm.nih.gov
- Locations
- Annals of Surgery (publishedVersion)
- PubMed Central (publishedVersion)
- PubMed (publishedVersion)
- Topics
- Health Sciences › Medicine › Surgery › Abdominal vascular conditions and treatments
- Health Sciences › Medicine › Surgery › Intestinal and Peritoneal Adhesions
- Health Sciences › Medicine › Gastroenterology › Gastrointestinal Bleeding Diagnosis and Treatment
- Keywords
- nonocclusive mesenteric ischemia, early diagnosis, prostaglandin E1, multidetector computed tomography, intestinal necrosis, multiple organ failure, postoperative ileus, cardiovascular surgery, dialysis, diagnostic criteria, survival
- MeSH terms
- Aged, Aged, 80 and over, Alprostadil, Diagnosis, Differential, Dose-Response Relationship, Drug, Female, Follow-Up Studies, Humans, Infusions, Intravenous, Intestines, Ischemia, Male, Mesenteric Arteries, Middle Aged, Time Factors, Tomography, X-Ray Computed, Vasodilator Agents, Survival Rate, Treatment Outcome
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