alexa Non-Occlusive Mesenteric Ischemia During the Course of Heart Failure
ISSN: 2165-7920

Journal of Clinical Case Reports
Open Access

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Case Report

Non-Occlusive Mesenteric Ischemia During the Course of Heart Failure

Nobuhiro Takeuchi1*, Shuho Semba2, Kazuyoshi Naba3, Tetsuo Maeda1 and Masanori Takada4
1Division of Gastroenterology, Department of Internal Medicine, Kawasaki Hospital, Japan
2Division of Pathology, Department of Pathology, Kobe University Graduate School of Medicine, Japan
3Department of Laboratory Medicine, Kawasaki Hospital, Japan
4Division of Cardiology, Department of Internal Medicine, Kawasaki Hospital, Japan
Corresponding Author : Nobuhiro Takeuchi, M.D
Division of Gastroenterology
Department of Internal Medicine
Kawasaki Hospital, 3-3-1 Higashiyama-cho
Kobe, Hyogo 652-0042, Japan
Tel: +81-78-511-3131
Fax: +81-78-511-3138
E-mail: [email protected]
Received October 13, 2012; Accepted October 26, 2012; Published October 29, 2012
Citation: Takeuchi N, Semba S, Naba K, Maeda T, Takada M (2012) Non- Occlusive Mesenteric Ischemia During the Course of Heart Failure. J Clin Case Rep 2:220. doi:10.4172/2165-7920.1000220
Copyright: © 2012 Takeuchi N, et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.
 

Abstract

An 89 year old female with a history of myocardial infarction, chronic heart failure, hypertension, and atrial fibrillation was transferred to our institution with circulatory insufficiency. The patient had been undergone treatment for in-stent restenosis of the middle left ascending artery 1 week back. Her systolic blood pressure was 70 mm Hg with evident cyanosis over the whole body surface. Arterial blood gas analysis revealed severe metabolic acidosis and the patient exhibited severe hypovolemia. Initiation of dopamine therapy and transfusion ameliorated the circulatory failure. Three days after admission, she discharged massive bloody stools without absence of abdominal pain; colonoscopy revealed segmental pattern of mucosa necrosis in the sigmoid colon. Enhanced abdominal computed tomography revealed neither thrombus nor embolus in the mesenteric artery. Blood flow to the sigmoid colon was evident, prompting a diagnosis of non-occlusive mesenteric ischemia. Although emergency surgery was recommended, the patient declined and died of panperitonitis following conservative therapy. In addition to circulatory insufficiency caused by heart failure in this case, the intestinal ischemia also resulted from hypovolemia, diuretics and digitalis therapy, and arteriosclerosis.

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