DOI: 10.36347/sjmcr.2017.v05i05.006

Pages: 314-316

An 85-year-old female who had fallen down and bumped her left hip into the floor 3 days earlier could not move due to the pain. She was transferred to a local medical facility and received a diagnosis of hypoglycemia, anemia, rhabdomyolysis, minor traumatic subarachnoid hemorrhage and pelvic fracture. She had no remarkable medical history. On arrival, she had subcutaneous hemorrhaging on her face and left hip. She complained of epigastralgia, but a physical examination of her abdomen revealed no suggestive findings. Whole-body CT revealed only pelvic fracture. She initially received a diagnosis of gastric ulcer due to stress concerning epigastralgia. She underwent massive infusion and transfusion; however, her oliguria did not improve. On the second hospital day, her epigastralgia continued. Her respiratory function deteriorated, so she received tracheal intubation with mechanical ventilation. As her oliguria did not respond to furosemide, continuous hemofiltration was also initiated. Vasopressor administration was also commenced for hypotension in order to maintain her blood pressure. However, her general condition did not improve, and her abdomen became distended. We suspected delayed intestinal injury due to trauma and performed enhanced CT on the fourth hospital day, which revealed segmental, enlarged, non-enhanced small bowel, corresponding to non-occlusive mesenteric ischemia (NOMI). Her family did not agree to surgical resection for the necrotic bowel because of her elderly age. Unfortunately, conservative therapy failed to obtain a successful outcome. Critical-care physicians should pay attention to complications of NOMI, especially when critical ill patients complain of epigastralgia.