Background: Nonocclusive mesenteric ischemia (NOMI) causes intestinal necrosis due to irreversible ischemia of the intestinal tract. The authors evaluated the incidence of NOMI in patients with subarachnoid hemorrhage (SAH) due to ruptured aneurysms, and they present the clinical characteristics and describe the outcomes to emphasize the importance of recognizing NOMI.
Observations: Overall, 7 of 276 consecutive patients with SAH developed NOMI. Their average age was 71 years, and 5 patients were men. Hunt and Kosnik grades were as follows: grade II, 2 patients; grade III, 3 patients; grade IV, 1 patient; and grade V, 1 patient. Fisher grades were as follows: grade 1, 1 patient; grade 2, 1 patient; and grade 3, 5 patients. Three patients were treated with endovascular coiling, 3 with microsurgical clipping, and 1 with conservative management. Five patients had abdominal symptoms prior to the confirmed diagnosis of NOMI. Four patients fell into shock. Two patients required emergent laparotomy followed by second-look surgery. Four patients could be managed conservatively. The overall mortality of patients with NOMI complication was 29% (2 of 7 cases).
Lessons: NOMI had a high mortality rate. Neurosurgeons should recognize that NOMI can occur as a fatal complication after SAH.
Keywords: 3D-CT = three-dimensional computed tomography; AKA = Adamkiewicz artery; CT = computed tomography; HK = Hunt and Kosnik; HPVG = hepatic portal venous gas; IC-PComA = internal carotid–posterior communicating artery; ICU = intensive care unit; MCA = middle cerebral artery; MDCT = multidetector-row computed tomography; MIP = maximum-intensity projection; NOMI = nonocclusive mesenteric ischemia; SAH = subarachnoid hemorrhage; SMA = superior mesenteric artery; complication; nonocclusive mesenteric ischemia; subarachnoid hemorrhage; vasospasm.
© 2022 The authors.