PDF(Pubmed)
Abstract：
There have been no case reports of non-occlusive mesenteric ischemia (NOMI) following head trauma. Our two patients with non-surgical traumatic intracerebral hemorrhage succumbed to NOMI one week after the injury. Both were women over age 80 years and were clinically improving before NOMI occurred. One patient had been eating since admission, while the other had not, which prompted the initiation of enteral nutrition on day 5. The patients shared many characteristics: 1) over age 80 years; 2) minor brain contusion; 3) constipation for a week; 4) minimal abdominal symptoms; 5) rapidly developing leukocytosis, hyperglycemia, hypernatremia, and elevated blood urea nitrogen; 6) massive diarrhea with a small amount of blood on the same day that laboratory data became abnormal; and 7) fever and shock developed shortly after diarrhea appeared. Because of the fulminant worsening of the condition, shock status, and old age, surgical intervention was considered high risk and not performed in either patient. In retrospect, if NOMI had been diagnosed earlier when the acute pancreatitis-like symptoms began, surgical intervention may have saved their lives. Clinicians should be aware that NOMI can occur after relatively minor head trauma, which can cause death if the diagnosis is delayed.
摘要：
没有关于头部创伤后非闭塞性肠系膜缺血（NOMI）的病例报道。我们的两名非手术性脑出血患者在受伤后一周死于NOMI。两人都是80岁以上的女性，在NOMI发生前临床症状有所改善。一名患者自入院以来一直在进食，而另一个没有，这促使在第5天开始肠内营养。患者具有许多特征：1）年龄超过80岁；2）轻度脑挫伤；3）便秘一周；4）腹部症状轻微；5）白细胞增多迅速发展，高血糖症,高钠血症,和血尿素氮升高；6）在实验室数据异常的同一天出现少量血液的大量腹泻；7）腹泻出现后不久出现发烧和休克。由于病情的暴发性恶化，休克状态,和老年，手术干预被认为是高风险的,未在任何一名患者中进行.回想起来，如果NOMI早在急性胰腺炎样症状开始时被诊断出来，手术干预可能挽救了他们的生命。临床医生应该意识到NOMI可以在相对较小的头部创伤后发生，如果诊断延迟，可能会导致死亡。
