Current diagnosis and therapy of non-occlusive mesenteric ischemia

Purpose: Non-occlusive mesenteric ischemia (NOMI) is a life threatening disease. Therapy and prognosis depend upon the length of time elapsed between primary clinical manifestation and the time of definitive diagnosis and treatment. Materials and Methods: NOMI was diagnosed by intraarterial selective angiography in four patients. After a bolus administration of 20 g Alprostadil (Prostavasin(R)) into the superior mesenteric artery, intraarterial perfusion was continued with 60 mug Alprostadil/day via the catheter for three days. Results: The mesenteric ischernia resolved in all patients. One patient recovered completely. Three patients recovered from mesenteric ischernia, but died subsequently due to complications of their primary diseases. Conclusion: When NOMI without perforation or necrosis of the bowel wall is suspected clinically, immediate intraarterial angiography is the diagnostic method of choice. If NOMI is confirmed, the appropriate treatment is the intraarterial application of potent vasodilators for several days. The diagnostic work-up in suspected NOMI and the impact of different radiological examinations are explained. The literature is reviewed.