Salamone G, Raspanti C, Licari L, Falco N, Rotolo G, Augello G, Melfa G, Gulotta G
G Chir. 2017 Mar-Apr;38(2):71-76. doi: 10.11138/gchir/2017.38.2.071.
Non-occlusive mesenteric ischemia (NOMI) is a severe pathological condition characterized by signs and symptoms of bowel obstruction, intestinal necrosis resulting from acute and/or chronic inadequate blood perfusion, in the absence of an organic vascular obstruction detectable by imaging techniques. A 64 years old man case with a history of Parkinson's disease in high-functioning levodopa treatment is presented. Clinical and radiological signs of intestinal obstruction were observed. He underwent surgical operation with total colectomy and terminal ileostomy for generalized secondary peritonitis due to perforation of sigmoid colon. Ischemic pancolitis was first suspected. In third post-operative day a contrastenhanced CT scan was performed in the evidence of fever and sub-occlusive symptoms. It was found absence of reliable evidence of vascular changes; superior mesenteric artery and vein patency is maintained A NOMI was then diagnosed. NOMI represents about 0.04% of mesenteric artery diseases. It is correlated with a poor prognosis with a mortality estimated of 70-90%. Parkinson's disease, considering neurodegenerative alterations that characterize it, can be considered as a predisposing factor. The combined treatment with high doses of levodopa and vasodilators, such as PGE (Prostaglandin E), can contribute to an improvement in prognosis.
非闭塞性肠系膜缺血（NOMI）是一种严重的病理状况，其特征为肠梗阻的体征和症状，以及因急性和/或慢性血液灌注不足导致的肠坏死，而影像学检查未发现器质性血管阻塞。本文介绍了一例64岁男性病例，该患者有帕金森病病史，正在接受高效左旋多巴治疗。观察到肠梗阻的临床和放射学体征。由于乙状结肠穿孔导致广泛性继发性腹膜炎，他接受了全结肠切除术和末端回肠造口术的手术治疗。最初怀疑为缺血性全结肠炎。术后第三天，在出现发热和亚闭塞症状的情况下进行了增强CT扫描。结果发现没有可靠的血管变化证据；肠系膜上动脉和静脉保持通畅，随后诊断为NOMI。NOMI约占肠系膜动脉疾病的0.04%。其预后较差，估计死亡率为70-90%。考虑到帕金森病所具有的神经退行性改变，可将其视为一个易感因素。高剂量左旋多巴与血管扩张剂（如前列腺素E）联合治疗有助于改善预后。
