Severe Non-Occlusive Mesenteric Ischemia without Lactate Elevation

Non-occlusive mesenteric ischemia is frequent in critically ill patients with hemodynamic instability. Plasma Lactate is a marker of tissue hypoperfusion and its diagnostic significance in the setting of mesenteric ischemia remains controversial. We present a case of severe non-occlusive mesenteric ischemia without lactate elevation over normal values although extended intestinal necrosis requiring right hemicolectomy and total ileoectomy was present. Serial lactate concentration measurements were insufficient to detect intestinal hypoperfusion and predict the length of bowel necrosis.The pre-and postoperative clinical monitoring was subsequently guided by vasoactive medication demand.