Fulminant nonocclusive mesenteric ischemia developing just after esophagectomy.

Nonocclusive mesenteric ischemia (NOMI) is a poorly understood condition, marked by progressive ischemia of the intestine leading to infarction, sepsis and death. The mortality rate remains high. Three cases of NOMI occurred after esophagectomy at our facility. It was suspected, through investigation of these cases, that NOMI occurring after major surgical procedures like esophagectomy has a far more rapid and progressive clinical course and high mortality rate. Therefore, it should be distinguished from spontaneously developing NOMI. A huge water shift between the intravascular space and the extravascular space during and just after surgery is suspected to have played a major role in the development of post-operative NOMI. Diagnosis and treatment of NOMI after a major surgery are quite difficult.