Difficult Diagnosis of Non-occlusive Mesenteric Ischemia in a Hemodialysis-dependent Patient in an Emergent Setting: A Case Report

Background: Non-occlusive mesenteric ischemia (NOMI) was first described in 1958 as a type of mesenteric ischemia with no evident occlusion of mesenteric arteries. It is a rare, devastating disease. Case Presentation: A hemodialysis (HD)-dependent man aged 72 years visited our emergency department for abdominal pain that had begun immediately after eating dinner the previous day, which was also the day the last HD was performed. He returned home after his pain subsided to a considerable extent. On the following day, his pain recurred, and abdominal examination revealed clinical signs of peritonitis. Exploratory laparotomy and surgical pathology findings of the intestine suggested NOMI. Postoperatively, anastomotic leakage was suspected, and an emergent operation was performed. However, the patient died 18 days after the second emergent operation. Conclusion: Emergency physicians should pay attention to postprandial abdominal pain in patients who present with high-risk factors for NOMI.