A Case of Difficult Diagnosis of Superior Mesenteric Arterial Obstrcution

Kenji Tezuka¹⁾, Naoyoshi Onoda¹⁾²⁾ , Yukio Nishiguchi¹⁾, Nobuya Yamada¹⁾, Kiyoshi Maeda¹⁾, Masaichi Ohira¹⁾, Tetsuro Ishikawa¹⁾, Junichi Hara³⁾, Nobuhide Oshitani³⁾ and Kosei Hirakawa¹⁾

First Department of Surgery¹⁾, Department of Oncology, Institute of Geriatrics and Medical Science²⁾ and Third Department of Internal Medicine³⁾, Osaka City University Medical School

Ischemic enteritis is an uncommon occurence, and is seldom diagnosed before operation. We describe a case of superior mesenteric arterial obstruction, which was diagnosed by abdominal angiography, and a review the Japanese literature of inchemic enteritis. A 51-year old woman was admitted to our hospital because of abdominal pain and watery diarrhea. Contrast radiography of the small intestine showed a segmental stenosis and longitudinal ulcer at the terminal ileum. The patient's symptoms were suggestive of Crohn's disease, and conservative treatment improved her symptoms. However, these symptoms recurred repeatedly with the resumption of oral diet. Abdominal CT detected two infarcted lesions of the spleen and the right kidney which suggested a systemic vascular disease. Abdominal angiography revealed an obstruction of the superior mesenteric artery in the middle of the surgical trunk with collateral circulation. Under the diagnosis of ischemic enteritis complicated with small intestinal stricture, partial resection of the ileum was performed 4 monthes after the onset of the disease. Pathological examination revealed a deep ulcer with severe granulation, prominent fibrosis, and hemosiderin devoured by macrophages.

Key words
ischemic enteritis, intestinal stricture, angiography

Reprint requests
Kenji Tezuka 1st Department of Surgery, Osaka City University Medical School 1-4-3 Asahi-machi, Abeno-ku, Osaka, 545-8585 JAPAN

Accepted
January 26, 2000

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