Successful treatment of non-occlusive mesenteric ischemia in a patient undergoing combined therapy with peritoneal dialysis and hemodialysis: a case report.

Abstract

A Japanese man in his 60 s with end-stage kidney disease due to diabetic nephropathy, who initially underwent peritoneal dialysis (PD) and was transferred to combined PD and hemodialysis (HD) therapy 4 years prior, was admitted to our hospital for surgical treatment of lumbar spinal canal stenosis. His rehabilitation continued well after successful surgery; however, he suddenly presented with abdominal pain and cloudy peritoneal dialysate, along with an increased white blood cell count in the peritoneal dialysate effluent, suggesting PD-associated peritonitis. Intraperitoneal administration of antibiotics was ineffective, and contrast-enhanced computed tomography showed areas of poor contrast enhancement and pneumatosis intestinalis in the colon. Emergency laparotomy revealed non-occlusive mesenteric ischemia (NOMI), leading to intestinal resection with ileostomy creation. He made good progress after the surgery and was eventually discharged while receiving thrice-weekly HD. NOMI is a well-known life-threatening condition, and its outcomes in patients receiving dialysis therapy are reportedly unfavorable. Furthermore, to our knowledge, there have been no reported cases of NOMI in patients receiving combined PD and HD therapy. Further accumulation of similar cases is needed to clarify appropriate approaches for treating NOMI in these patients.