Mesenteric ischemia with pneumatosis intestinalis and portal vein gas associated with enteral nutrition: a series of three patients

Enteral nutrition is usually associated with a low risk of intestinal complications. We report three non-critically ill patients who received enteral nutrition and developed mesenteric ischemia with pneumatosis intestinalis and hepatic portal vein gas. These findings are often considered to be indications for emergency surgery. In these three patients, prompt cessation of enteral nutrition avoided progression to intestinal necrosis obviating the need for intestinal resection, although one patient underwent surgical exploration. Follow-up computed tomography scan showed resolution of the radiologic findings, and all patients started enteral nutrition again without complications. All patients had comorbidities associated with atherosclerosis, which may have led to a mismatch between oxygen delivery and demand in the bowel, resulting in ischemia. To the best of our knowledge, this is the first report of successful management of mesenteric ischemia related to enteral nutrition in non-critically ill patients without resection. If the cause of mesenteric ischemia such as enteral nutrition, can be eliminated quickly, non-resectional and possibly nonoperative management can be a reasonable management option, with close follow-up and readiness for resection.