Abstract
BackgroundChronic mesenteric ischemia (CMI) is a rare disease; however, symptomatic CMI has a risk of acute exacerbation without timely revascularization.Case presentationA 54-year-old man who had had postprandial pain for 6 months was admitted to our hospital because of vomiting and diarrhea. Although the celiac and superior mesenteric arteries were occluded at the proximal portion, contrast enhancement of the bowel wall was good in contrast-enhanced computed tomography (CECT). Endoscopic examination revealed only a healed gastric ulcer and slight mucosal erosions in the colon. He was diagnosed as having acute enteritis or inflammatory digestive disease and observed with conservative therapy, which improved his acute symptoms. On hospitalization day 42, he suddenly complained of lower back pain. CECT showed abdominal free air, which indicated gastrointestinal perforation. Emergency surgery was performed for jejunum resection. Two days later, a second operation was performed for a leak in the anastomotic site of the jejunum. Necrotic change in the small intestinal serosa was also observed and required broad resection of the small intestine. He was diagnosed with acute exacerbation of CMI, and we performed surgical retrograde bypass to the gastroduodenal artery using a saphenous vein graft as the third operation. After the surgery, he was free from digestive symptoms and was discharged.ConclusionsWhen patients complain of chronic and gradual digestive symptoms, we should always consider symptomatic CMI. Timely mesenteric revascularization is important for symptomatic CMI before severe complications occur.
Highlights
Chronic mesenteric ischemia (CMI) is a rare disease; symptomatic CMI has a risk of acute exacerbation without timely revascularization.Case presentation: A 54-year-old man who had had postprandial pain for 6 months was admitted to our hospital because of vomiting and diarrhea
Mesenteric revascularization is important for symptomatic CMI before severe complications occur
Case presentation A 54-year-old man who had had postprandial pain for 6 months was admitted to our gastroenterology ward because of vomiting and diarrhea over a few days
Summary
Chronic mesenteric ischemia (CMI) is an unusual pathology because there is usually abundant collateral circulation among the mesenteric arteries [1,2,3]. Case presentation A 54-year-old man who had had postprandial pain for 6 months was admitted to our gastroenterology ward because of vomiting and diarrhea over a few days. While he had been performed an abdominal surgery due to intussusception 21 years ago, the detail was not available. We confirmed the graft patency by CECT (Fig. 3) and the recovery of the gastroduodenal mucosa by endoscopic examination (Fig. 2c). His symptoms subsided, and he was discharged from our hospital 62 days after the revascularization.
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