Nonocclusive mesenteric ischemia secondary to antihypertensive drug overdose successfully managed with early extracorporeal membrane oxygenation

Abstract Background Nonocclusive mesenteric ischemia (NOMI) is a life-threatening complication of systemic hypoperfusion. Case presentation A woman in her 50s presented with refractory hypotension after intentional overdose of amlodipine (150 mg), candesartan (240 mg), and imeglimin (24,500 mg). Computed tomography revealed portal venous gas and intestinal edema, findings consistent with NOMI. Despite vasopressor support, circulatory instability persisted, and venoarterial extracorporeal membrane oxygenation (VA-ECMO) was initiated. After stabilization on VA-ECMO, contrast-enhanced CT on day 2 showed reduced enhancement of the small bowel. Exploratory laparotomy revealed edematous but viable intestine, allowing us to avoid resection. The patient recovered fully and was transferred to psychiatry without complications. Conclusion This case highlights the potential role of early ECMO initiation as a bridge to recovery in stabilizing hemodynamics and preserving intestinal viability in NOMI secondary to drug-induced hypotension, particularly when instituted before irreversible intestinal necrosis develops.