Diagnosis and treatment of nonocclusive mesenteric ischemia after open heart surgery

Background. Acute nonocclusive mesenteric ischemia (NOMI) is a rare but often fatal event after cardiac surgery. Methods. Twenty patients with ongoing ileus after cardiac surgery despite maximal laxative treatment underwent selective mesenteric angiography. In cases of pathological radiographic findings, papaverine was continuously administered via an intraarterial perfusion catheter. Results. Severe NOMI was confirmed in seven patients (mean lactate: 6.9 ± 8.3 mg/dL), mild to moderate findings in another seven (mean lactate: 1.4 ± 1.1 mg/dL). One patient had thromboembolic occlusion of the superior mesenteric artery; five patients demonstrated normal imaging findings. In nine of fourteen patients (64%) treated with papaverine, symptoms improved within hours (defecation occurred after 4–29 hours, mean 13 ± 8.1 hours). No side effects or complications occurred in connection with the papaverine treatment. The clinical condition of five patients deteriorated. Four patients underwent laparotomy with creation of an ileostomy or colostomy, two of whom presented with severe intestinal ischemia and later died. One patient died prior to laparotomy. Conclusions. Selective mesenteric angiography with continuous papaverine administration is a simple, fast, and effective diagnostic and therapeutic tool to reduce the need for laparotomy for symptoms of ileus after open-heart surgery.