Koizumi Hiroyuki, Yamamoto Daisuke, Maruhashi Takaaki, Kataoka Yuichi, Inukai Madoka, Asari Yasushi, Kumabe Toshihiro
Departments of1Neurosurgery and.
2Emergency and Critical Care Medicine, Kitasato University School of Medicine, Sagamihara, Kanagawa, Japan.
J Neurosurg Case Lessons. 2022 Jul 18;4(3):CASE22199. doi: 10.3171/CASE22199.
Nonocclusive mesenteric ischemia (NOMI) causes intestinal necrosis due to irreversible ischemia of the intestinal tract. The authors evaluated the incidence of NOMI in patients with subarachnoid hemorrhage (SAH) due to ruptured aneurysms, and they present the clinical characteristics and describe the outcomes to emphasize the importance of recognizing NOMI.
Overall, 7 of 276 consecutive patients with SAH developed NOMI. Their average age was 71 years, and 5 patients were men. Hunt and Kosnik grades were as follows: grade II, 2 patients; grade III, 3 patients; grade IV, 1 patient; and grade V, 1 patient. Fisher grades were as follows: grade 1, 1 patient; grade 2, 1 patient; and grade 3, 5 patients. Three patients were treated with endovascular coiling, 3 with microsurgical clipping, and 1 with conservative management. Five patients had abdominal symptoms prior to the confirmed diagnosis of NOMI. Four patients fell into shock. Two patients required emergent laparotomy followed by second-look surgery. Four patients could be managed conservatively. The overall mortality of patients with NOMI complication was 29% (2 of 7 cases).
NOMI had a high mortality rate. Neurosurgeons should recognize that NOMI can occur as a fatal complication after SAH.
非闭塞性肠系膜缺血（NOMI）由于肠道不可逆缺血导致肠坏死。作者评估了因动脉瘤破裂导致蛛网膜下腔出血（SAH）患者中NOMI的发生率，并呈现其临床特征并描述结局，以强调认识NOMI的重要性。
总体而言，276例连续SAH患者中有7例发生NOMI。他们的平均年龄为71岁，5例为男性。Hunt和Kosnik分级如下：Ⅱ级2例；Ⅲ级3例；Ⅳ级1例；Ⅴ级1例。Fisher分级如下：1级1例；2级1例；3级5例。3例接受血管内栓塞治疗，3例接受显微手术夹闭，1例接受保守治疗。5例在确诊NOMI之前有腹部症状。4例发生休克。2例需要紧急剖腹手术并二次探查。4例可保守治疗。NOMI并发症患者的总体死亡率为29%（7例中的2例）。
NOMI死亡率高。神经外科医生应认识到NOMI可能作为SAH后的致命并发症发生。
