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Superior mesenteric arterial branch occlusion causing partial jejunal ischemia: a case report.

Van De Winkel N, Cheragwandi A, Nieboer K, van Tussenbroek F, De Vogelaere K, Delvaux G - J Med Case Rep (2012)

Bottom Line: Computed tomography of her abdomen as well as computed tomography enterography, enteroscopy, angiography and small bowel enteroclysis demonstrated an ischemic jejunal segment caused by occlusion of a branch of the superior mesenteric artery.The diagnosis of segmental small bowel ischemia was confirmed by histopathological study.To the best of our knowledge, this is the first report presenting a case of acute mesenteric ischemia with segmental superior mesenteric artery occlusion.

View Article: PubMed Central - HTML - PubMed

Affiliation: Department of Abdominal Surgery, UZ Brussel, Vrije Universiteit Brusse, Brussels, Belgium. nele.vandewinkel@uzbrussel.be.

ABSTRACT

Introduction: Ischemic bowel disease comprises both mesenteric ischemia and colonic ischemia. Mesenteric ischemia can be divided into acute and chronic ischemia. These are two separate entities, each with their specific clinical presentation and diagnostic and therapeutic modalities. However, diagnosis may be difficult due to the vague symptomatology and subtle signs.

Case presentation: We report the case of a 68-year-old Caucasian woman who presented with abdominal discomfort, anorexia, melena and fever. A physical examination revealed left lower quadrant tenderness and an irregular pulse. Computed tomography of her abdomen as well as computed tomography enterography, enteroscopy, angiography and small bowel enteroclysis demonstrated an ischemic jejunal segment caused by occlusion of a branch of the superior mesenteric artery. The ischemic segment was resected and an end-to-end anastomosis was performed. The diagnosis of segmental small bowel ischemia was confirmed by histopathological study.

Conclusion: Mesenteric ischemia is a pathology well-known by surgeons, gastroenterologists and radiologists. Acute and chronic mesenteric ischemia are two separate entities with their own specific clinical presentation, radiological signs and therapeutic modalities. We present the case of a patient with symptoms and signs of chronic mesenteric ischemia despite an acute etiology. To the best of our knowledge, this is the first report presenting a case of acute mesenteric ischemia with segmental superior mesenteric artery occlusion.

No MeSH data available.


Related in: MedlinePlus

Enteroclysis, revealing the loss of the normal mucosal pattern of the jejunal segment of the small bowel, suggesting ischemia.
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Figure 3: Enteroclysis, revealing the loss of the normal mucosal pattern of the jejunal segment of the small bowel, suggesting ischemia.

Mentions: On physical examination, tender palpation in the left lower quadrant of her abdomen with slight rebound pain was noted. An irregular pulse was also discovered. An electrocardiogram detected paroxysmal atrial fibrillation. Her white blood cell count and C-reactive protein level were elevated. Computed tomography (CT) of her abdomen and CT enterography revealed a stenotic jejunal segment with reduced enhancement of her bowel wall and the presence of inflammation in her left iliac fossa (Figure 1). Enteroscopy showed jejunal ulceration and necrosis one meter distal to the angle of Treitz. Intra-arterial digital subtraction angiography (IADSA) revealed an occlusion of a branch originating from the superior mesenteric artery with collateral vascularization (Figure 2). An enteroclysis confirmed the diagnosis of segmental jejunal ischemia (Figure 3).


Superior mesenteric arterial branch occlusion causing partial jejunal ischemia: a case report.

Van De Winkel N, Cheragwandi A, Nieboer K, van Tussenbroek F, De Vogelaere K, Delvaux G - J Med Case Rep (2012)

Enteroclysis, revealing the loss of the normal mucosal pattern of the jejunal segment of the small bowel, suggesting ischemia.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC3298780&req=5

Figure 3: Enteroclysis, revealing the loss of the normal mucosal pattern of the jejunal segment of the small bowel, suggesting ischemia.
Mentions: On physical examination, tender palpation in the left lower quadrant of her abdomen with slight rebound pain was noted. An irregular pulse was also discovered. An electrocardiogram detected paroxysmal atrial fibrillation. Her white blood cell count and C-reactive protein level were elevated. Computed tomography (CT) of her abdomen and CT enterography revealed a stenotic jejunal segment with reduced enhancement of her bowel wall and the presence of inflammation in her left iliac fossa (Figure 1). Enteroscopy showed jejunal ulceration and necrosis one meter distal to the angle of Treitz. Intra-arterial digital subtraction angiography (IADSA) revealed an occlusion of a branch originating from the superior mesenteric artery with collateral vascularization (Figure 2). An enteroclysis confirmed the diagnosis of segmental jejunal ischemia (Figure 3).

Bottom Line: Computed tomography of her abdomen as well as computed tomography enterography, enteroscopy, angiography and small bowel enteroclysis demonstrated an ischemic jejunal segment caused by occlusion of a branch of the superior mesenteric artery.The diagnosis of segmental small bowel ischemia was confirmed by histopathological study.To the best of our knowledge, this is the first report presenting a case of acute mesenteric ischemia with segmental superior mesenteric artery occlusion.

View Article: PubMed Central - HTML - PubMed

Affiliation: Department of Abdominal Surgery, UZ Brussel, Vrije Universiteit Brusse, Brussels, Belgium. nele.vandewinkel@uzbrussel.be.

ABSTRACT

Introduction: Ischemic bowel disease comprises both mesenteric ischemia and colonic ischemia. Mesenteric ischemia can be divided into acute and chronic ischemia. These are two separate entities, each with their specific clinical presentation and diagnostic and therapeutic modalities. However, diagnosis may be difficult due to the vague symptomatology and subtle signs.

Case presentation: We report the case of a 68-year-old Caucasian woman who presented with abdominal discomfort, anorexia, melena and fever. A physical examination revealed left lower quadrant tenderness and an irregular pulse. Computed tomography of her abdomen as well as computed tomography enterography, enteroscopy, angiography and small bowel enteroclysis demonstrated an ischemic jejunal segment caused by occlusion of a branch of the superior mesenteric artery. The ischemic segment was resected and an end-to-end anastomosis was performed. The diagnosis of segmental small bowel ischemia was confirmed by histopathological study.

Conclusion: Mesenteric ischemia is a pathology well-known by surgeons, gastroenterologists and radiologists. Acute and chronic mesenteric ischemia are two separate entities with their own specific clinical presentation, radiological signs and therapeutic modalities. We present the case of a patient with symptoms and signs of chronic mesenteric ischemia despite an acute etiology. To the best of our knowledge, this is the first report presenting a case of acute mesenteric ischemia with segmental superior mesenteric artery occlusion.

No MeSH data available.


Related in: MedlinePlus