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      Mesenteric ischemia masquerading as refractory peritonitis in continuous ambulatory peritoneal dialysis patients

      case-report

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          Abstract

          We report two cases of mesenteric ischemia in patients on long term peritoneal dialysis both of which were associated with poor outcomes. Both were diabetic and on peritoneal dialysis for a long time. On evaluation of refractory peritonitis we found evidence of non occlusive mesenteric ischemia. Despite adequate treatment both succumbed to their illness. Abdominal pathology, especially mesenteric ischemia leading to gut infarction, should be considered in patients with refractory peritonitis.

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          Nonocclusive mesenteric ischemia remains a diagnostic dilemma.

          Eric A. Wiebke, Jeffrey Howard, M Wilcox … (1996)
          Despite reports of low mortality and high bowel-salvage rates in nonocclusive mesenteric ischemia (NOMI), our experience has been much less favorable. This study analyzes our experience with NOMI. A retrospective chart review (1979 to 1992) identified 113 patients with acute mesenteric ischemia, of whom 13 (12%) met our criteria for NOMI. Patients were grouped into early and late presenters. The 5 early presenters were women, younger (mean age [+/- SD] 50 +/- 5.8 years), with no risk factors, and had vague symptoms leading to a delay in diagnosis. The 7 late presenters were older (mean age [+/- SD] 63 +/- 5.3 years) with identifiable risk factors; all had bowel infarction at the time of initial diagnosis. Vague symptoms and a wide range of patients at risk make early diagnosis of NOMI uncommon. In the absence of early diagnosis, bowel resection with its high morbidity and mortality remains the only applicable treatment option in the vast majority of patients.
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            Current theories of pathogenesis and treatment of nonocclusive mesenteric ischemia.

            Joseph L Unthank, Jeffrey Howard, L A Plaskon … (1995)
            Nonocclusive mesenteric ischemia (NOMI) is a poorly understood condition marked by progressive intestinal ischemia leading to infarction, sepsis, and death in a high proportion of patients. The mortality rate for this intestinal disorder remains high, even when the diagnosis is made early in the disease course. This paper presents a comprehensive review of NOMI with a detailed discussion of its history, pathophysiology, diagnosis, and treatment.
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              Direct vasopressor effect of recombinant human erythropoietin on renal resistance vessels.

              Stefan Heidenreich, Karl-Heinz Rahn, Walter Zidek (1991)
              The contractile properties of recombinant human erythropoietin (rHuEPO) on isolated resistance vessels of renal and mesenteric vascular beds were studied in an in vitro model using a small vessel myograph. Under isometric conditions, rHuEPO caused a contraction of this vasculature in a concentration range between 10 U/ml and 200 U/ml. A maximal active wall tension of 1.52 +/- 0.19 mN/mm was obtained under a rHuEPO dose of 200 U/ml. In Ca2+ free solution, the pressor response to high rHuEPO-concentrations was attenuated, and the response to low rHuEPO concentrations was abolished. In the presence of verapamil, phentolamine and saralasin, rHuEPO-induced contractions were not affected significantly. A dose-dependent vasodilatation of mounted vasculature to acetylcholine (ACh) indicated that endothelium remained intact in our preparations. rHuEPO-induced vessel contraction was not abrogated after an enzymatical removal of endothelium by collagenase, confirming that the described contractile responses are endothelial independent. These findings suggest that a direct vasopressor effect of rHuEPO on proximal resistance vessels may contribute to development of hypertension seen in rHuEPO-treated hemodialysis patients.
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                Author and article information

                Journal
                Journal ID (nlm-ta): Indian J Nephrol
                Journal ID (iso-abbrev): Indian J Nephrol
                Journal ID (publisher-id): IJN
                Title: Indian Journal of Nephrology
                Publisher: Medknow Publications & Media Pvt Ltd (India )
                ISSN (Print): 0971-4065
                ISSN (Electronic): 1998-3662
                Publication date (Print): Nov-Dec 2015
                Volume: 25
                Issue: 6
                Pages: 380-382
                Affiliations
                [1]Department of Nephrology, SGPGI, Lucknow, Uttar Pradesh, India
                [1 ]Department of Nephrology, Yashoda Hospitals, Secunderabad, Telangana, India
                Author notes
                Address for correspondence: Dr. Urmila Anandh, Department of Nephrology, Yashoda Hospitals, Alexander Road, Secunderabad - 500 003, Telangana, India. E-mail: uanandh@ 123456gmail.com
                Article
                Publisher ID: IJN-25-380
                DOI: 10.4103/0971-4065.160332
                PMC ID: 4663779
                SO-VID: ed6095fe-d36e-4a31-9bcb-c9ac05dd2092
                Copyright © Copyright: © Indian Journal of Nephrology
                License:

                This is an open access article distributed under the terms of the Creative Commons Attribution-NonCommercial-ShareAlike 3.0 License, which allows others to remix, tweak, and build upon the work non-commercially, as long as the author is credited and the new creations are licensed under the identical terms.

                History
                Categories
                Subject: Case Report

                ScienceOpen disciplines: Nephrology
                Keywords: ischemia,mesenteric,nonocclusive,peritonitis
                Data availability:
                ScienceOpen disciplines: Nephrology
                Keywords: ischemia, mesenteric, nonocclusive, peritonitis

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