Balancing Nutrition and Ischemia of Small Intestine: A Fatal Case of Non-Occlusive Mesenteric Ischemia Caused by Enteral Nutrition Following Esophagectomy

Abstract

Introduction: Non-occlusive mesenteric ischemia （NOMI） is a rare but potentially fatal complication of postoperative enteral nutrition, reported following surgeries for gastrointestinal cancers, including esophageal cancer. Case presentation: A 77-yearold male underwent thoracoscopic-assisted subtotal esophagectomy. Enteral nutrition was initiated gradually and initially well-tolerated. On postoperative day （POD） 5, the patient developed reduced urine output, mild abdominal distension, and diarrhea, which temporarily improved. However, on POD 6, he experienced cardiopulmonary arrest. Imaging revealed portal vein and intestinal emphysema as NOMI. Emergency surgery revealed extensive intestinal necrosis due to vascular spasm. Despite the intervention, the patient succumbed to multiple organ failure on POD 7. Conclusion: NOMI seems to be exacerbated by high-osmolarity enteral nutrition and bacterial overgrowth. Typical early symptoms of NOMI did not exist, and diagnosis was challenging. This case highlights the need for careful monitoring during enteral nutrition in high-risk patients and emphasizes the importance of early detection and individualized management to prevent NOMI-related complications.