Buerger's disease presenting as acute small bowel ischemia

Intestinal Type of Thromboangiitis Obliterans (Buerger Disease) Preceding Symptoms of Severe Peripheral Arterial Disease

“…It is also unusual that he had no symptoms of claudication. There are previous reports of only four patients in whom intestinal manifestations of thromboangiitis obliterans preceded localization to the limbs (7,8,11,15). There are also only a few reported cases of perforation of the intestine due to this disease (5,6,8,16).…”

“…In 1924, Buerger, who originally described thromboangiitis obliterans characterized by distal peripheral arterial and/or venous involvement, showed possible involve- (6) ment of mesenteric vessels based on four patients (1,2). Thereafter few histologically proven cases have included digestive tract involvement in this disease (7)(8)(9)(10)(11)(12)(13). The small bowel is more often affected than the colon.…”

“…Small branches of the coeliac and mesenteric arteries are most often involved. Segmental ischaemic changes are the most common manifestations both in small intestine and colon (7,13).…”

“…Buerger disease affects both the arteries and veins principally of the lower and upper limbs (4). The intestinal vessels are rarely affected (3,(5)(6)(7). Subjects under 40 years of age with a history of heavy smoking are predisposed to this disease (8).…”

Distribution of arterial involvement in thromboangiitis obliterans (buerger’s disease): Results of a study conducted by the Intractable Vasculitis syndromes research group in Japan

“…Broide and associates reported the case of a young man with the unusual presentation of small bowel ischemia associated with TAO, 2 years before peripheral vascular disease of the extremities was clinically expressed. 15 Schellong and associates also reported the case of a 23-year-old smoker with extended thrombophlebitis who developed severe abdominal angina and liver hypoxia due to occlusion of the celiac artery and subtotal occlusion of the superior mesenteric artery, and reviewed the literature pertinent to intestinal TAO since 1945. 11 In most cases of intestinal-type TAO, the symptoms of onset were abdominal angina or intestinal perforation that required emergency surgery.…”