Surgery for acute exacerbation of chronic mesenteric ischemia: a case report

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.

A case of chronic mesenteric ischemia managed by ascending aorta to superior mesenteric and hepatic artery bypass

“…5 Van De Winkel et al managed a case of SMA occlusion causing partial jejunal ischemia by resecting the stenotic ischemic jejunal segment and performing an end-to-end anastomosis. 6 A case of acute exacerbation of CMI was managed by surgical retrograde bypass to the gastroduodenal artery using a saphenous vein graft by Abe et al 7 …”