Tube Enteral Feeding-Associated Non-Occlusive Mesenteric Ischemia following Gastric Cancer Surgery: A Retrospective Case Series Analysis.

Abstract

Introduction: Non-occlusive mesenteric ischemia (NOMI) is a rare but lethal complication after gastric cancer (GC) surgery, marked by intestinal hypoperfusion without arterial occlusion. Nonspecific symptoms and rapid deterioration hinder timely diagnosis. This study evaluated outcomes, diagnostic pathways, and management.

Methods: We retrospectively reviewed 8 GC patients who developed NOMI (February 2022-January 2024). Collected variables included demographics, surgical details, feeding practices, presentation, imaging, treatment, and outcomes. The primary endpoint was 30-day mortality.

Results: NOMI presented a median of 3 days postoperatively (range 2-5). The median age was 63.5 years; 75% were male; all had advanced GC; and 62.5% had gastric outlet obstruction. Common signs were abdominal distension (75%), hypotension (50%), and peritonitis (25%). CT consistently showed small-bowel dilatation, pneumatosis intestinalis, and portal venous gas, mainly in distal jejunum/ileum. Seven patients underwent re-exploration: five required resection. After implementing a modified feeding protocol, cases reduced from seven to one. Thirty-day mortality was 50%, largely from sepsis and multiorgan dysfunction syndrome.

Conclusion: In GC patients with feeding jejunostomy, NOMI remains a serious complication. A cautious feeding strategy - deferring feeds during vasopressor support, initiating low-strength kitchen feeds, slow escalation, and early oral intake - was associated with fewer cases. High clinical suspicion, rapid CT, and timely surgery are critical to improve outcomes.