Department of Surgery, Houju Memorial Hospital, 11-71 Midorigaoka, Nomi, Ishikawa, 923-1226, Japan.
Clin J Gastroenterol. 2021 Jun;14(3):776-781. doi: 10.1007/s12328-021-01379-6. Epub 2021 Mar 7.
Nonocclusive mesenteric ischemia (NOMI) is a life-threatening disease caused by a reduction in mesenteric blood supply without vascular occlusion. Early diagnosis of NOMI is often difficult because there are no specific findings suggesting NOMI. Here, we report a rare case of a very elderly patient with mild NOMI caused by dehydration due to short-term reduced oral intake and associated with syncope. A 90-year-old man was admitted to our hospital with syncope and melena. The syncope was thought to be caused by orthostatic hypotension due to dehydration owing to reduced oral intake for approximately 24 h. Abdominal computed tomography (CT) revealed marked bowel wall thickening with mesenteric stranding in the ileum and ascending colon, dilated small intestine with thinned bowel wall, collapsed superior mesenteric vein, hemorrhagic ascites, and absence of obvious vascular occlusion in the mesenteric vessels. Abdominal symptoms, laboratory abnormalities, and CT findings improved gradually with the correction of dehydration. Therefore, we diagnosed our patient with mild NOMI. NOMI can be associated with syncope and can occur even with dehydration due to short-term reduced oral intake. When examining elderly patients with hypovolemic signs, such as syncope, who exhibit abdominal symptoms, clinicians must keep in mind the possibility of NOMI.
非闭塞性肠系膜缺血（NOMI）是一种由肠系膜血液供应减少而没有血管阻塞引起的危及生命的疾病。由于没有提示 NOMI 的特定发现，因此早期诊断 NOMI 通常很困难。在这里，我们报告了一例非常罕见的老年患者病例，该患者因短期减少口服摄入导致脱水而引起轻度 NOMI，并伴有晕厥。一名 90 岁男性因晕厥和黑便而被收入我院。晕厥被认为是由于脱水引起的直立性低血压引起的，这是由于大约 24 小时的口服摄入减少所致。腹部计算机断层扫描（CT）显示回肠和升结肠有明显的肠壁增厚和肠系膜缠结，小肠扩张，肠壁变薄，肠系膜上静脉塌陷，血性腹水，肠系膜血管无明显阻塞。腹部症状、实验室异常和 CT 发现随着脱水的纠正逐渐改善。因此，我们诊断患者为轻度 NOMI。NOMI 可与晕厥相关，甚至可因短期减少口服摄入而导致脱水。当检查有晕厥等低血容量体征的老年患者时，临床医生必须记住 NOMI 的可能性。
