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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

Perioperative image of the resected ischemic jejunal segment.
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Figure 4: Perioperative image of the resected ischemic jejunal segment.

Mentions: Our patient was transferred to the Department of Abdominal Surgery for exploratory surgery. The stenotic ischemic jejunal segment was resected and an end-to-end anastomosis was performed (Figure 4). A histopathological study revealed a small bowel stricture 10 cm in length, as well as multiple ulcerations with granulation tissue, thickened vascular endothelium and inflammatory infiltrate. These findings corresponded with the clinical and surgical diagnosis of segmental small bowel ischemia.


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)

Perioperative image of the resected ischemic jejunal segment.
© Copyright Policy - open-access
Related In: Results  -  Collection

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

Figure 4: Perioperative image of the resected ischemic jejunal segment.
Mentions: Our patient was transferred to the Department of Abdominal Surgery for exploratory surgery. The stenotic ischemic jejunal segment was resected and an end-to-end anastomosis was performed (Figure 4). A histopathological study revealed a small bowel stricture 10 cm in length, as well as multiple ulcerations with granulation tissue, thickened vascular endothelium and inflammatory infiltrate. These findings corresponded with the clinical and surgical diagnosis of segmental small bowel ischemia.

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