Umer Farooq, MD1, Daniel Alcantar, MD1, Zahoor Ahmed, MBBS2, Ayokunle T. Abegunde, MD, MSc, MRCGP3; 1Loyola Medicine/MacNeal Hospital, Berwyn, IL; 2King Edward Medical University, Berwyn, IL; 3Loyola University Medical Center, Maywood, IL
Introduction: Nonocclusive mesenteric ischemia (NOMI) is due to severe mesenteric arterial hypoperfusion with secondary arterial spasm from several causes, such as hypovolemia, heart failure, shock, vasoconstrictors, and severe liver or renal disease. Vasoconstrictor-induced NOMI is usually iatrogenic or associated with cocaine use. Anecdotal reports suggest that cocaine-induced NOMI has the highest mortality among vasoconstrictors. There is limited epidemiologic data in the published literature related to NOMI. This review aims to compare the outcomes of large bowel NOMI secondary to cocaine versus other vasoconstrictors. Methods: We conducted a systematic search of MEDLINE from inception through October 2016. The search was restricted to English-language studies conducted in human subjects. Studies of large bowel NOMI were included if data were available on comorbidities, mortality, and hospital length of stay (LOS). Articles were excluded if patients had a secondary or significant concomitant reason to develop colon ischemia (e.g., volvulus, septic, or cardiogenic shock). Primary outcomes of the study were mortality and hospital LOS, while secondary outcomes included the need for surgery, LACE index, and Hospital score. We reported descriptive statistics as percentages or median and interquartile range (IQR). We compared continuous data with the Mann-Whitney test and categorical data with Fisher’s exact test, P< 0.05 was statistically significant. Results: Of the 59 studies, 20 case reports, and 3 case series (n= 27 patients) met the inclusion criteria (Figure 1). The culprit vasoconstrictors other than cocaine were -triptans, ergotamine, vasopressin and its analogs, and phenylpropanolamine (Table 1). There was no difference in mortality between cocaine-induced NOMI and non-cocaine NOMI (P=1.0). There were statistically significant differences between cocaine and non-cocaine vasoconstrictor-induced large bowel NOMI regarding surgery (60% vs. 5.8%, P=0.035) and median LOS (7 days vs. 4 days, p=0.04). There was no statistically significant difference in the median Hospital score or LACE index between the two groups (Table 2). Discussion: Cocaine-induced NOMI and non-cocaine NOMI both appear to have a relatively high but similar mortality rate, but the former is associated with increased requirement for surgery and LOS; prompt recognition of this clinical entity is required to improve outcomes. Large-scale and well-designed observational studies are needed to investigate this topic further.
Disclosures: Umer Farooq indicated no relevant financial relationships. Daniel Alcantar indicated no relevant financial relationships. Zahoor Ahmed indicated no relevant financial relationships. Ayokunle Abegunde indicated no relevant financial relationships.