Nonocclusive mesenteric ischemia associated with a hyperosmolar hyperglycemic state: Hepatic portal venous gas as an indicator of mesenteric ischemia. Issue 1 (30th June 2021)

• Record Type: Journal Article
• Authors: Takiguchi, Toru; Arai, Masatoku; Kim, Shiei; Ishii, Hiromoto; Ogasawara, Tomoko; Shigeta, Kenta; Mizobuchi, Taiki; Yokobori, Shoji
• Is Part Of: Acute medicine & surgery. Volume 8:Issue 1(2021)
• Page Start: n/a
• Page End: n/a
• Publication Date: 2021-06-30
• Subjects: Computed tomography -- diabetes -- hepatic portal venous gas -- hyperosmolar hyperglycemic state -- nonocclusive mesenteric ischemia; Surgery -- Periodicals; Medical emergencies -- Periodicals; 617.005
• DOI: 10.1002/ams2.673
• Languages: English
• ISSNs: 2052-8817

Abstract

Abstract : Background: The diagnosis of nonocclusive mesenteric ischemia (NOMI) is always challenging in critically ill patients. Herein, we aimed to report a case of NOMI associated with a hyperosmolar hyperglycemic state (HHS). A small amount of hepatic portal venous gas (HPVG) triggered the diagnosis of NOMI. Case Presentation: A 77‐year‐old man was transferred due to shock and disorder of consciousness. He was diagnosed with an HHS. We suspected intestinal ischemia due to a small amount of HPVG revealed by computed tomography (CT). Peritoneal signs were revealed after treatment for the HHS. Computed tomography was carried out again 5 h after admission, which showed a large amount of HPVG, remarkable bowel dilatation, and pneumatosis intestinalis. We performed an emergency laparotomy and resected the small bowel necrosis resulting from NOMI. Conclusion: An HHS can cause NOMI, and the presence of HPVG on CT is an important finding that suggests mesenteric ischemia, even in small amounts. Abstract : The diagnosis of nonocclusive mesenteric ischemia (NOMI) is always challenging in critically ill patients. We reported a case of NOMI associated with a hyperosmolar hyperglycemic state. A small amount of hepatic portal venous gas triggered the diagnosis of NOMI.