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

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Title: Surgery for acute exacerbation of chronic mesenteric ischemia : a case report
Authors: Abe, Shinji Browse this author
Yamakawa, Tomoji Browse this author
Kawashima, Hideaki Browse this author
Yoshida, Makoto Browse this author
Takanashi, Setsuji Browse this author
Kashiyama, Motoya Browse this author
Ishigooka, Masahiro Browse this author
Shingu, Yasushige Browse this author
Matsui, Yoshiro Browse this author →KAKEN DB
Keywords: Chronic mesenteric ischemia
Surgical revascularization
Issue Date: 5-Dec-2016
Publisher: Springer
Journal Title: Surgical case reports
Volume: 2
Start Page: 146
Publisher DOI: 10.1186/s40792-016-0272-0
Abstract: Background: Chronic mesenteric ischemia (CMI) is a rare disease; however, 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. 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. Conclusions: When 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.
Rights: https://creativecommons.org/licenses/by/4.0/
Type: article
URI: http://hdl.handle.net/2115/64473
Appears in Collections:北海道大学病院 (Hokkaido University Hospital) > 雑誌発表論文等 (Peer-reviewed Journal Articles, etc)

Submitter: 松居 喜郎

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