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Introduction <p>Non-occlusive mesenteric ischemia (NOMI) is a subtype of acute mesenteric ischemia characterized by bowel hypoperfusion without major vessel occlusion, most often occurring in states of systemic circulatory stress.</p> Case Presentation <p>We report a delayed postoperative NOMI in a 69-year-old man one month after minimally invasive McKeown esophagectomy with feeding jejunostomy, following unsupervised home-based jejunal feeds and diabetic ketoacidosis (DKA). Although subtle radiologic abnormalities were present (ileal hypoenhancement and distal SMA branch attenuation), they were insufficient to definitively diagnose bowel ischemia, necessitating reliance on clinical deterioration and prompt surgical exploration. Emergency laparotomy revealed segmental small-bowel necrosis with patent mesenteric vessels; histopathology confirmed transmural ischemic necrosis without thrombotic occlusion.</p> Conclusion <p>NOMI is a rare but life-threatening postoperative complication, particularly in patients receiving jejunal feeds and experiencing circulatory or metabolic stress. In this case, unsupervised home-based feeding and DKA likely acted as precipitating factors for mesenteric hypoperfusion, culminating in segmental bowel necrosis. Because imaging may be insufficiently definitive, clinicians should rely on clinical deterioration to guide early operative intervention. Standardised feeding protocols, explicit discharge education, and vigilant metabolic surveillance-especially in diabetic patients-are essential to mitigate risk and improve outcomes.</p>

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Non-occlusive Bowel Ischemia Following Jejunostomy Feeding and Diabetic Ketoacidosis in a Post-esophagectomy Patient: A Case Report

  • 期刊论文

  • 发表日期：

    2026年6月30日

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  • Ananth S. Mathad,
  • Rohan Patil,
  • Adarsh Hegde,
  • Akhil Palod,
  • Naveena A. N. Kumar

摘要

Introduction

Non-occlusive mesenteric ischemia (NOMI) is a subtype of acute mesenteric ischemia characterized by bowel hypoperfusion without major vessel occlusion, most often occurring in states of systemic circulatory stress.

Case Presentation

We report a delayed postoperative NOMI in a 69-year-old man one month after minimally invasive McKeown esophagectomy with feeding jejunostomy, following unsupervised home-based jejunal feeds and diabetic ketoacidosis (DKA). Although subtle radiologic abnormalities were present (ileal hypoenhancement and distal SMA branch attenuation), they were insufficient to definitively diagnose bowel ischemia, necessitating reliance on clinical deterioration and prompt surgical exploration. Emergency laparotomy revealed segmental small-bowel necrosis with patent mesenteric vessels; histopathology confirmed transmural ischemic necrosis without thrombotic occlusion.

Conclusion

NOMI is a rare but life-threatening postoperative complication, particularly in patients receiving jejunal feeds and experiencing circulatory or metabolic stress. In this case, unsupervised home-based feeding and DKA likely acted as precipitating factors for mesenteric hypoperfusion, culminating in segmental bowel necrosis. Because imaging may be insufficiently definitive, clinicians should rely on clinical deterioration to guide early operative intervention. Standardised feeding protocols, explicit discharge education, and vigilant metabolic surveillance-especially in diabetic patients-are essential to mitigate risk and improve outcomes.