PMC5394210_01
The serum lactate levels and clinical course in the Intensive Care Unit.
gr1.jpg
PMC5394210_01_gr1.jpg
fig0005
Contrast-enhanced computed tomography (CT) scan of the abdomen and angiography of the superior mesenteric artery (SMA) were performed (Fig. 1(A)). Emergent exploratory laparotomy was then performed (Fig. 1(B)), with no obvious ischemic changes of the intestine seen intraoperatively. The decision was made to perform a second exploratory laparotomy (Fig. 1(C)). Another angiography study showed no narrowing or arterial obstruction (Fig. 1(D)).
Superior mesenteric arteriography. Superior mesenteric arteriography shows discontinuous flow (arrow) with multiple areas of stenosis (arrow heads).
gr2.jpg
PMC5394210_01_gr2.jpg
fig0010
CT scan, poor contrast enhancement was found in some areas of the small intestine with narrowing and blocking of distal branches of the SMA (Fig. 2), leading to the diagnosis of NOMI. Continuous intra-arterial infusion of papaverine was started via a catheter placed in the SMA.
Intraoperative findings at the second laparotomy, 38 h after Intensive Care Unit admission. Extensive segmental ischemia is observed.
gr3.jpg
PMC5394210_01_gr3.jpg
fig0015
Intraoperative findings showed ischemic changes in the celiac artery distribution extending from the stomach to the descending limb of the duodenum with extensive segmental ischemic changes in the SMA distribution (Fig. 3), but no areas appeared to require resection at that time.