A case of diabetic ketoacidosis comorbid with nonocclusive mesenteric ischemia in a severely dehydrated type 2 diabetic patient

A 65-year-old male was diagnosed with type 2 diabetes five years before admission and discontinued his prescribed oral medications on his own initiative two years before admission. He experienced a disturbance of consciousness while working in the hot sun. Upon being transferred to the hospital by ambulance, his chief complaint was vomiting. A plasma glucose level of 1,516 mg/dl, positive results for blood and urine ketones, metabolic acidosis and severe dehydration were noted. Diabetic ketoacidosis was diagnosed, and the patient was admitted to the hospital. On the second day after admission, a decreased level of consciousness indicated low blood pressure and poor oxygenation due to hypovolemic shock secondary to dehydration. Contrast-enhanced computed tomography of the abdomen showed portal venous gas and extensive intramural intestinal gas. In addition, bloody ascites fluid with an abnormal odor was sampled via an abdominal tap. Subsequently, nonocclusive mesenteric ischemia (NOMI) associated with intestinal necrosis was diagnosed. Life-saving emergency extended right hemicolectomy was performed. NOMI has a high mortality rate. Making an immediate and proper diagnosis is critical for providing appropriate treatment, although accurately diagnosing the condition is difficult due to the lack of characteristic abdominal findings.