A Case of Nonocclusive Mesenteric Ischemia induced by Diabetic Ketoacidosis due to Fulminant Type 1 Diabetes

Shingo Oya, Kanji Miyata, Norihiro Yuasa, Eiji Takeuchi, Yasutomo Goto, Hideo Miyake, Keiichi Nagasawa, Kenji Omori and Yoichiro Kobayashi

Department of Surgery, Japanese Red Cross Nagoya Daiichi Hospital

A 64-year-old man brought by ambulance to the hospital due to vomiting, consciousness disturbance and dysbasia was found in laboratory findings to have diabetic ketoacidosis, and dehydration, suggesting pancreatitis. During conservative 24-hour treatment, abdominal tenderness developed, creatine kinase rapidly elevated and computed tomography disclosed a thickened segmental intestinal wall with an indistinct border, ascites, and pleural effusion. Thus, these clinical findings necessitated emergency surgery. Laparotomy showed multiple spotted necroses of the distal ileum. The superior mesenteric artery and its main branches pulsated, yielding a diagnosis of nonocclusive mesenteric ischemia (NOMI), necessitating partial resection of the ileum. The postoperative course was uneventful. NOMI is intestinal tract ischemia caused by contraction of the mesenteric artery in patients with systemic low perfusion. Given normal serum HbA1c and decreased urinal C-peptide, we definitively diagnosed this case as fulminant type 1 diabetes, which should be considered in cases of diabetic ketoacidosis without a history of diabetes. The importance of following up closely on physical abdominal findings and imaging in diagnosing cases of acute abdomen in subjects with consciousness disturbance cannot be overemphasized.

Key words
nonocclusive mesenteric ischemia, diabetic ketoacidosis, fulminant type 1 diabetes

Reprint requests
Shingo Oya Department of Surgery, Toyohashi Municipal Hospital
50 Aza Hachiken Nishi, Aotake-cho, Toyohashi, 441-8570 JAPAN

Accepted
January 27, 2010

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