A Case of Non-Occlusive Mesenteric Ischemia (NOMI) which Recovered Completely with Continuous Intra-Arterial Perfusion of Papaverine Hydrocholoride

• Published in: Nihon Fukubu Kyukyu Igakkai Zasshi (Journal of Abdominal Emergency Medicine) Vol. 29; no. 7; pp. 1017 - 1020
• Main Authors: Endo, Ayako, Yamada, Yasuo, Saito, Toshihiro, Takeda, Kazunori, Kikuchi, Shu
• Format: Journal Article
• Language: Japanese
• Published: Japanese Society for Abdominal Emergency Medicine 30.11.2009
• Subjects: interventional radiology (IVR); non-occlusive mesenteric ischemia (NOMI)
• ISSN: 1340-2242; 1882-4781
• DOI: 10.11231/jaem.29.1017

A 63-year-old male with sudden abdominal pain went to a hospital and a superior mesenteric artery (SMA) embolism was suspected based on abdominal CT findings. The patient was brought to our hospital in good general condition but with tenderness in the lower abdominal region. Blood chemistry revealed a high lactic acid value at 31.3 mg/dL. CT revealed that there was no embolism in the SMA, a poorly enhanced area was observed in parts of the ileum, and the mesentery was edematous. Based on these findings, our diagnosis was non-occlusive mesenteric ischemia (NOMI). The angiographic findings resembled those on CT. No improvement of the arterial narrowing was achieved following injection of papaverine hydrocholoride, but the abdominal pain improved markedly. CT just after this exam revealed improvement in the ischemic changes of the ileum, and the lactic acid levels returned to normal. Based on these findings we believed that no necrosis existed in the small intestine. Angiography 48 hrs after the continuous infusion of papaverine hydrocholoride demonstrated improvement of the narrowing of the ileal arteries. The patient's course was uneventful after this and he was discharged on the 13th hospital day.