Successful surgical treatment for nonocclusive mesenteric ischemia of a wide area of the intestine accompanied by gastric conduit necrosis after esophagectomy for esophageal cancer: a case report and review of the literature
Abstract Background Nonocclusive mesenteric ischemia (NOMI) has been reported to be a life-threating disease. Gastric conduit necrosis is known as a critical postoperative complication after esophagectomy for esophageal cancer. We encountered a rare case of NOMI of a wide area of the intestine accom...
Saved in:
| Main Authors: | , , , , , , , , , , , , |
|---|---|
| Format: | Article |
| Language: | English |
| Published: |
Japan Surgical Society
2020-06-01
|
| Series: | Surgical Case Reports |
| Subjects: | |
| Online Access: | http://link.springer.com/article/10.1186/s40792-020-00890-1 |
| Tags: |
Add Tag
No Tags, Be the first to tag this record!
|
| _version_ | 1849397312661487616 |
|---|---|
| author | Kotaro Miura Naoshi Kubo Katsunobu Sakurai Yutaka Tamamori Akihiro Murata Takafumi Nishii Shintaro Kodai Akiko Tachimori Sadatoshi Shimizu Akishige Kanazawa Toru Inoue Yukio Nishiguchi Kiyoshi Maeda |
| author_facet | Kotaro Miura Naoshi Kubo Katsunobu Sakurai Yutaka Tamamori Akihiro Murata Takafumi Nishii Shintaro Kodai Akiko Tachimori Sadatoshi Shimizu Akishige Kanazawa Toru Inoue Yukio Nishiguchi Kiyoshi Maeda |
| author_sort | Kotaro Miura |
| collection | DOAJ |
| description | Abstract Background Nonocclusive mesenteric ischemia (NOMI) has been reported to be a life-threating disease. Gastric conduit necrosis is known as a critical postoperative complication after esophagectomy for esophageal cancer. We encountered a rare case of NOMI of a wide area of the intestine accompanied by gastric conduit necrosis after esophagectomy, which was successfully treated with an emergency operation. Case presentation A 67-year-old man presented with dysphagia. He was diagnosed with middle thoracic advanced esophageal cancer. After neoadjuvant chemotherapy, he underwent subtotal esophagectomy with lymphadenectomy and gastric conduit reconstruction. On postoperative day (POD) 2, he had diarrhea, high fever, and low blood pressure, which were treated with catecholamines. Laboratory data revealed acidosis and severe sepsis with multi-organ failure, including the kidneys. Although enhanced computed tomography did not exhibit definite findings of bowel ischemia, upper gastrointestinal endoscopy revealed necrotic mucosal changes in the whole gastric conduit. Therefore, we made a diagnosis of septic shock caused by gastric conduit necrosis and performed an emergency operation. When we explored the abdominal cavity, we found not only gastric conduit necrosis but also intermittent necrotic changes in the intestinal wall from the jejunum to the rectum. Therefore, NOMI was diagnosed. We performed an excision of the gastric conduit and 2 m of the small intestine, as well as total colectomy. After the second operation, prostaglandin E1 was administered intravenously as the treatment for NOMI, and sepsis was improved. On POD 122, he was self-discharged. He died of recurrence of lung metastasis from the esophageal cancer 9 months after the first operation. Conclusion When a patient has a critical status, including severe sepsis or severe acidosis, after esophagectomy, we should consider the possibility of NOMI in addition to gastric conduit necrosis and aim to diagnose and treat it immediately with an urgent operation. |
| format | Article |
| id | doaj-art-bf519fd3ab6a41cda30d39e103dddf4d |
| institution | Kabale University |
| issn | 2198-7793 |
| language | English |
| publishDate | 2020-06-01 |
| publisher | Japan Surgical Society |
| record_format | Article |
| series | Surgical Case Reports |
| spelling | doaj-art-bf519fd3ab6a41cda30d39e103dddf4d2025-08-20T03:39:04ZengJapan Surgical SocietySurgical Case Reports2198-77932020-06-01611910.1186/s40792-020-00890-1Successful surgical treatment for nonocclusive mesenteric ischemia of a wide area of the intestine accompanied by gastric conduit necrosis after esophagectomy for esophageal cancer: a case report and review of the literatureKotaro Miura0Naoshi Kubo1Katsunobu Sakurai2Yutaka Tamamori3Akihiro Murata4Takafumi Nishii5Shintaro Kodai6Akiko Tachimori7Sadatoshi Shimizu8Akishige Kanazawa9Toru Inoue10Yukio Nishiguchi11Kiyoshi Maeda12Department of Gastroenterological Surgery, Osaka City General HospitalDepartment of Gastroenterological Surgery, Osaka City General HospitalDepartment of Gastroenterological Surgery, Osaka City General HospitalDepartment of Gastroenterological Surgery, Osaka City General HospitalDepartment of Hepato-Biliary Pancreatic Surgery, Osaka City General HospitalDepartment of Gastroenterological Surgery, Osaka City General HospitalDepartment of Hepato-Biliary Pancreatic Surgery, Osaka City General HospitalDepartment of Gastroenterological Surgery, Osaka City General HospitalDepartment of Hepato-Biliary Pancreatic Surgery, Osaka City General HospitalDepartment of Hepato-Biliary Pancreatic Surgery, Osaka City General HospitalDepartment of Surgery, Osaka City Juso HospitalDepartment of Surgery, Osaka City Juso HospitalDepartment of Gastroenterological Surgery, Osaka City General HospitalAbstract Background Nonocclusive mesenteric ischemia (NOMI) has been reported to be a life-threating disease. Gastric conduit necrosis is known as a critical postoperative complication after esophagectomy for esophageal cancer. We encountered a rare case of NOMI of a wide area of the intestine accompanied by gastric conduit necrosis after esophagectomy, which was successfully treated with an emergency operation. Case presentation A 67-year-old man presented with dysphagia. He was diagnosed with middle thoracic advanced esophageal cancer. After neoadjuvant chemotherapy, he underwent subtotal esophagectomy with lymphadenectomy and gastric conduit reconstruction. On postoperative day (POD) 2, he had diarrhea, high fever, and low blood pressure, which were treated with catecholamines. Laboratory data revealed acidosis and severe sepsis with multi-organ failure, including the kidneys. Although enhanced computed tomography did not exhibit definite findings of bowel ischemia, upper gastrointestinal endoscopy revealed necrotic mucosal changes in the whole gastric conduit. Therefore, we made a diagnosis of septic shock caused by gastric conduit necrosis and performed an emergency operation. When we explored the abdominal cavity, we found not only gastric conduit necrosis but also intermittent necrotic changes in the intestinal wall from the jejunum to the rectum. Therefore, NOMI was diagnosed. We performed an excision of the gastric conduit and 2 m of the small intestine, as well as total colectomy. After the second operation, prostaglandin E1 was administered intravenously as the treatment for NOMI, and sepsis was improved. On POD 122, he was self-discharged. He died of recurrence of lung metastasis from the esophageal cancer 9 months after the first operation. Conclusion When a patient has a critical status, including severe sepsis or severe acidosis, after esophagectomy, we should consider the possibility of NOMI in addition to gastric conduit necrosis and aim to diagnose and treat it immediately with an urgent operation.http://link.springer.com/article/10.1186/s40792-020-00890-1Mesenteric ischemiaPostoperative complicationsEsophagectomy |
| spellingShingle | Kotaro Miura Naoshi Kubo Katsunobu Sakurai Yutaka Tamamori Akihiro Murata Takafumi Nishii Shintaro Kodai Akiko Tachimori Sadatoshi Shimizu Akishige Kanazawa Toru Inoue Yukio Nishiguchi Kiyoshi Maeda Successful surgical treatment for nonocclusive mesenteric ischemia of a wide area of the intestine accompanied by gastric conduit necrosis after esophagectomy for esophageal cancer: a case report and review of the literature Surgical Case Reports Mesenteric ischemia Postoperative complications Esophagectomy |
| title | Successful surgical treatment for nonocclusive mesenteric ischemia of a wide area of the intestine accompanied by gastric conduit necrosis after esophagectomy for esophageal cancer: a case report and review of the literature |
| title_full | Successful surgical treatment for nonocclusive mesenteric ischemia of a wide area of the intestine accompanied by gastric conduit necrosis after esophagectomy for esophageal cancer: a case report and review of the literature |
| title_fullStr | Successful surgical treatment for nonocclusive mesenteric ischemia of a wide area of the intestine accompanied by gastric conduit necrosis after esophagectomy for esophageal cancer: a case report and review of the literature |
| title_full_unstemmed | Successful surgical treatment for nonocclusive mesenteric ischemia of a wide area of the intestine accompanied by gastric conduit necrosis after esophagectomy for esophageal cancer: a case report and review of the literature |
| title_short | Successful surgical treatment for nonocclusive mesenteric ischemia of a wide area of the intestine accompanied by gastric conduit necrosis after esophagectomy for esophageal cancer: a case report and review of the literature |
| title_sort | successful surgical treatment for nonocclusive mesenteric ischemia of a wide area of the intestine accompanied by gastric conduit necrosis after esophagectomy for esophageal cancer a case report and review of the literature |
| topic | Mesenteric ischemia Postoperative complications Esophagectomy |
| url | http://link.springer.com/article/10.1186/s40792-020-00890-1 |
| work_keys_str_mv | AT kotaromiura successfulsurgicaltreatmentfornonocclusivemesentericischemiaofawideareaoftheintestineaccompaniedbygastricconduitnecrosisafteresophagectomyforesophagealcanceracasereportandreviewoftheliterature AT naoshikubo successfulsurgicaltreatmentfornonocclusivemesentericischemiaofawideareaoftheintestineaccompaniedbygastricconduitnecrosisafteresophagectomyforesophagealcanceracasereportandreviewoftheliterature AT katsunobusakurai successfulsurgicaltreatmentfornonocclusivemesentericischemiaofawideareaoftheintestineaccompaniedbygastricconduitnecrosisafteresophagectomyforesophagealcanceracasereportandreviewoftheliterature AT yutakatamamori successfulsurgicaltreatmentfornonocclusivemesentericischemiaofawideareaoftheintestineaccompaniedbygastricconduitnecrosisafteresophagectomyforesophagealcanceracasereportandreviewoftheliterature AT akihiromurata successfulsurgicaltreatmentfornonocclusivemesentericischemiaofawideareaoftheintestineaccompaniedbygastricconduitnecrosisafteresophagectomyforesophagealcanceracasereportandreviewoftheliterature AT takafuminishii successfulsurgicaltreatmentfornonocclusivemesentericischemiaofawideareaoftheintestineaccompaniedbygastricconduitnecrosisafteresophagectomyforesophagealcanceracasereportandreviewoftheliterature AT shintarokodai successfulsurgicaltreatmentfornonocclusivemesentericischemiaofawideareaoftheintestineaccompaniedbygastricconduitnecrosisafteresophagectomyforesophagealcanceracasereportandreviewoftheliterature AT akikotachimori successfulsurgicaltreatmentfornonocclusivemesentericischemiaofawideareaoftheintestineaccompaniedbygastricconduitnecrosisafteresophagectomyforesophagealcanceracasereportandreviewoftheliterature AT sadatoshishimizu successfulsurgicaltreatmentfornonocclusivemesentericischemiaofawideareaoftheintestineaccompaniedbygastricconduitnecrosisafteresophagectomyforesophagealcanceracasereportandreviewoftheliterature AT akishigekanazawa successfulsurgicaltreatmentfornonocclusivemesentericischemiaofawideareaoftheintestineaccompaniedbygastricconduitnecrosisafteresophagectomyforesophagealcanceracasereportandreviewoftheliterature AT toruinoue successfulsurgicaltreatmentfornonocclusivemesentericischemiaofawideareaoftheintestineaccompaniedbygastricconduitnecrosisafteresophagectomyforesophagealcanceracasereportandreviewoftheliterature AT yukionishiguchi successfulsurgicaltreatmentfornonocclusivemesentericischemiaofawideareaoftheintestineaccompaniedbygastricconduitnecrosisafteresophagectomyforesophagealcanceracasereportandreviewoftheliterature AT kiyoshimaeda successfulsurgicaltreatmentfornonocclusivemesentericischemiaofawideareaoftheintestineaccompaniedbygastricconduitnecrosisafteresophagectomyforesophagealcanceracasereportandreviewoftheliterature |