Ischemic enteritis with intestinal stenosis

Abstract

A 75-year-old man was admitted to our hospital with sudden onset of vomiting and abdominal distension. The patient was taking medication for arrhythmia. Computed tomography showed stenosis of the ileum and a small bowel dilatation on the oral side from the region of stenosis. A transnasal ileus tube was placed. Enteroclysis using contrast medium revealed an approximately 6-cm afferent tubular stenosis 10 cm from the terminal ileum and thumbprinting in the proximal bowel. Transanal double-balloon enteroscopy showed a circumferential shallow ulcer with a smooth margin and edema of the surrounding mucosa. The stenosis was so extensive that we could not perform endoscopic balloon dilation therapy. During hospitalization, the patient's nutritional status deteriorated. In response, we surgically resected the region of stenosis. Histologic examination revealed disappearance of the mucosal layer and transmural ulceration with marked fibrosis, especially in the submucosal layer. Hemosiderin staining revealed sideroferous cells in the submucosal layers. Based on the pathologic findings, the patient was diagnosed with ischemic enteritis. The patient's postoperative course was uneventful.

Ultrasonographic and histopathological features in 8 cats with fibrotic small intestinal stricture

“…This course accounts for the protracted waxing and waning clinical history encountered with intestinal stricture, often with temporary improvement, finally presenting with delayed signs of bowel obstruction. 10,22,26 The histopathological changes and protracted clinical progression in the cats in this report closely correlate this pattern of ischemic intestinal disease. In these cats, except for mild hyperemia and small hemorrhages, considered more likely to be the result of inflammation rather than the primary cause of the tissue damage/stricture, there was no evidence of other significant vascular change.…”

“…This is followed by a reparative phase with granulation tissue formation, chronic inflammation, and mural fibrosis, and a delayed phase associated with stenosis. This course accounts for the protracted waxing and waning clinical history encountered with intestinal stricture, often with temporary improvement, finally presenting with delayed signs of bowel obstruction . The histopathological changes and protracted clinical progression in the cats in this report closely correlate this pattern of ischemic intestinal disease.…”

“…Multiple factors may be implicated and the etiology may indeed differ between annular and long‐segment strictures. In humans, bowel stricture is usually recognized as a complication of chronic inflammatory intestinal diseases (particularly Crohn's disease) but is also associated with adhesions, bowel incarceration, the use of non‐steroidal anti‐inflammatory drugs, ischemia, and neoplasia . The principal underlying factors implicated in the development of stricture are bowel inflammation, bowel ischemia, and direct mucosal damage , .…”

“…In these cats, except for mild hyperemia and small hemorrhages, considered more likely to be the result of inflammation rather than the primary cause of the tissue damage/stricture, there was no evidence of other significant vascular change. Ischemic bowel disease without major vascular occlusion or histological evidence of thrombosis may occur due to vasospasm, cardiogenic shock, or low‐output states . In humans, it is usually associated with cardiovascular diseases such as atrial fibrillation and vasculitis .…”

“…22,26 In humans, it is usually associated with cardiovascular diseases such as atrial fibrillation and vasculitis. 26 Therefore, the two cats presented with aortic thromboembolism and congestive heart failure associated with cardiomyopathy after successful resection of their strictures warrants consideration. Whether ischemic disease was primarily responsible for benign stricture in these cats is uncertain but the predominant mucosal distribution of the histopathological changes implicates ischemia in the evolution of the strictures irrespective of the primary mechanism involved.…”