Open AccessNonocclusive mesenteric ischemia associated with a hyperosmolar hyperglycemic state: Hepatic portal venous gas as an indicator of mesenteric ischemia
Author(s) -
Takiguchi Toru,
Arai Masatoku,
Kim Shiei,
Ishii Hiromoto,
Ogasawara Tomoko,
Shigeta Kenta,
Mizobuchi Taiki,
Yokobori Shoji
Publication year - 2021
Publication title -
acute medicine and surgery
Language(s) - English
Resource type - Journals
ISSN - 2052-8817
DOI - 10.1002/ams2.673
Subject(s) - medicine , laparotomy , mesenteric ischemia , ischemia , pneumatosis intestinalis , shock (circulatory) , septic shock , radiology , sepsis , gastroenterology , surgery
Background The diagnosis of nonocclusive mesenteric ischemia (NOMI) is always challenging in critically ill patients. Herein, we aimed to report a case of NOMI associated with a hyperosmolar hyperglycemic state (HHS). A small amount of hepatic portal venous gas (HPVG) triggered the diagnosis of NOMI. Case Presentation A 77‐year‐old man was transferred due to shock and disorder of consciousness. He was diagnosed with an HHS. We suspected intestinal ischemia due to a small amount of HPVG revealed by computed tomography (CT). Peritoneal signs were revealed after treatment for the HHS. Computed tomography was carried out again 5 h after admission, which showed a large amount of HPVG, remarkable bowel dilatation, and pneumatosis intestinalis. We performed an emergency laparotomy and resected the small bowel necrosis resulting from NOMI. Conclusion An HHS can cause NOMI, and the presence of HPVG on CT is an important finding that suggests mesenteric ischemia, even in small amounts.