Non-occlusive mesenteric ischemia secondary to diabetic ketoacidosis in a patient receiving olanzapine: A case report

Non-occlusive mesenteric ischemia is a life-threatening condition caused by mesenteric vasoconstriction without arterial occlusion. Early diagnosis remains challenging because of nonspecific clinical symptoms. Here, we report a case of non-occlusive mesenteric ischemia associated with a hyperglycemic crisis in a patient treated with olanzapine. A 29-year-old man presented with altered mental status, abdominal pain, and diarrhea. Laboratory assessment revealed severe hyperglycemia, ketosis, dehydration, and acute kidney injury. Non-contrast abdominal computed tomography (CT) demonstrated pneumatosis intestinalis. After four days, follow-up contrast-enhanced CT revealed diffuse lack of bowel wall enhancement consistent with severe bowel ischemia. No occlusive lesion of the superior mesenteric artery was identified. The patient was diagnosed with non-occlusive mesenteric ischemia based on imaging findings and systemic hypoperfusion due to diabetic ketoacidosis. This case highlights the limitations of non-contrast CT in suspected bowel ischemia and the importance of early contrast-enhanced CT, even in patients with renal dysfunction, because delayed diagnosis may lead to irreversible bowel necrosis.