Chemotherapy Associated Nonocclusive Mesenteric Ischemia During Chemoradiation Therapy for Esophageal Cancer: A Case Report

Nonocclusive mesenteric ischemia (NOMI) is a type of intestinal ischemia without organic vascular obstruction that carries high mortality rates, making it a critical condition with a poor prognosis. This report describes a case involving a 71-year-old man with esophageal cancer who developed NOMI during chemoradiation therapy. After initiation of chemoradiation therapy with combined 5-fluorouracil and cisplatin, the patient experienced acute abdominal pain and hypotension. Imaging findings suggested NOMI of the distal ileum. Early intervention rapidly decreased his symptoms and improved his vital signs, thereby avoiding surgical treatment. Thus, the patient received conservative treatment and completed his radiation therapy as scheduled without recurrence of symptoms, although chemotherapy was discontinued. To our knowledge, this is the first reported case of chemotherapy-associated NOMI successfully managed with conservative treatment alone, highlighting the potential effectiveness of early therapeutic intervention before the condition progresses to severe ischemia.