Septic state and ileus as the late complications of non-occlusive mesenteric ischemia — case report

Abstract

Acute bowel ischemia is a relatively rare condition, but with a very serious prognosis. It may be caused by obstruction of the visceral artery, arterial spasm or reduction in visceral perfusion (NOMI, non-occlusive ischemia), or visceral venous thrombosis. In this paper we present a case of a male patient, in whom during septic shock in the course of pneumonia, probably NOMI occurred. The consequence of this complication were recurrent febrile states and rapidly progressing, multisegmental narrowing of the small bowel resulting in the ileus within four months. It required small bowel resection, ileostomia and parenteral nutrition. We failed to sufficiently document the source of these late NOMI complications and introduce the surgery before dissemination of infection of faecal streptococci. These infection focuses were likely the source of nutritional catheter contagion and recurrent septic conditions, which together with stroke, finally caused patient’s death.