Ikeda Atsushi, Yamada Shinichi, Ishizaka Risa, Sakurai Kotaro, Takatsuka Danki, Takaichi Mayu, Fujiwara Kumiko, Noguchi Makoto
Department of Oral and Maxillofacial Surgery, Faculty of Medicine, Academic Assembly, University of Toyama, Toyama 930-0194, Japan.
Department of Dentistry and Oral Surgery, Faculty of Medicine, Osaka Medical and Pharmaceutical University, Takatsuki, Osaka 569-8686, Japan.
Biomed Rep. 2024 Sep 19;21(6):172. doi: 10.3892/br.2024.1860. eCollection 2024 Dec.
Non-occlusive mesenteric ischaemia (NOMI) refers to irreversible intestinal ischaemia and necrosis in the absence of organic obstruction to the mesenteric blood vessels. In cases of delayed diagnosis, the prognosis is poor and the mortality rate is 58-70%, being the highest among patients with acute mesenteric ischaemia. The risk factors for this disease include heart disease, sepsis, and administration of catecholamines and digitalis; however, there are few reports of its onset during drug therapy for malignant tumours. The present study reported the case of an 85-year-old man who developed NOMI during drug therapy for maxillary cancer. The patient was diagnosed with right maxillary carcinoma, for which paclitaxel, carboplatin and cetuximab (PCE) therapy was administered. Four days after starting the second course of PCE therapy, the patient visited the emergency department of our hospital with chief complaints of melena and abdominal pain. Contrast-enhanced computed tomography revealed ischaemia from the transverse to the descending colon, leading to a diagnosis of NOMI. Colectomy and colostomy were performed during the emergency surgery on the same day. Although the patient's general condition improved, he was transferred to a recuperation facility for palliative care.
非闭塞性肠系膜缺血(NOMI)是指在肠系膜血管无器质性阻塞的情况下发生的不可逆性肠缺血和坏死。若诊断延误,预后较差,死亡率为58%-70%,是急性肠系膜缺血患者中死亡率最高的。该病的危险因素包括心脏病、脓毒症以及儿茶酚胺和洋地黄的使用;然而,关于其在恶性肿瘤药物治疗期间发病的报道较少。本研究报告了1例85岁男性在接受上颌癌药物治疗期间发生NOMI的病例。该患者被诊断为右上颌癌,接受了紫杉醇、卡铂和西妥昔单抗(PCE)治疗。在开始第二疗程PCE治疗4天后,患者因黑便和腹痛为主诉就诊于我院急诊科。增强计算机断层扫描显示横结肠至降结肠缺血,诊断为NOMI。同日急诊手术行结肠切除术和结肠造口术。尽管患者的一般状况有所改善,但仍被转至康复机构接受姑息治疗。