S3516 A Case of Recurrent Thromboangiitis Obliterans (Buerger's Disease) in a Patient With Abdominal Pain and Intestinal Transplant

Abstract

Introduction: We describe a case of abdominal pain and recurrent disease following intestinal transplant in a patient with a history of mesenteric ischemia and Thromboangiitis obliterans (Buerger's syndrome) that did not resolve with standard medical therapy. Case Description/Methods: A wonderful 44 year old female presents with intestinal infarction. The patient required three prior revascularization procedures with acute on chronic mesenteric ischemia with superior mesenteric artery thrombosis. She was taken to the operating room for necrotic small bowel with resection 20 centimeters distal to the ligament of treitz and placed on parenteral nutrition. Following recurrent episodes of line related bacteremia and fungemia she was listed for intestinal transplantation. After being off tobacco for a year she received and small bowel and right colon transplant. She had initial anticoagulation which was restarted four year later after a deep venous thrombosis to the lower extremity. Seven years following transplant the patient had inconsistent use of the anticoagulation along with recurrent tobacco abuse and developed recurrent mesenteric ischemia with acute on chronic occlusion of the celiac trunk, superior mesenteric artery, and inferior abdominal aorta leading to generalized abdominal pain, ischemic colitis and septic shock. Given recurrent abdominal infections patient had enterectomy 8 years and six months following intestinal transplantation. The patient subsequently developed bacteremia, candidemia and line related thrombosis. Patient had eventual transition to palliative management and died. Discussion: Buerger's disease (also known as thromboangiitis obliterans) affects blood vessels in the body, most commonly in the arms and legs. The use of tobacco is essential for both the initiation and progression of this disease. Blood vessels swell, which can prevent blood flow, causing clots to form. This can lead to pain, tissue damage, and even gangrene. It is typically treated with medications that dilate blood vessels, improve blood flow or dissolve blood clots, such as anticoagulants. Ongoing tobacco cessation is vital to success following rare intestinal transplantation. We present a case of intestinal transplant for Buerger’s Disease with recurrent thrombosis seven years following intestinal transplant attributed to recurrent tobacco abuse.