Idiopathic Ischemic Enteritis with Multiple Strictures Suffering from Repeating Ileus for 4 Years: A Case Report

Seiki Miura, Nobuhiro Takiguchi, Hiroaki Soda, Matsuo Nagata, Hiroshi Yamamoto and Takehide Asano

Chiba Cancer Center

A 76-year-old man seen in 1999 for epigastralgia, anorexia, and weight loss underwent examination and conservative management with placement of a nasogastric tube under a diagnosis of ileus. Relief was temporary and episodes repeated for four years. Admitted for detailed examinations in 2003, he was found in barium examination of the small intestine to have segmental stenosis and dilation of the oral side of the ileum. Conservative therapy was again ineffective, necessitating surgery was performed. On operation, we found three-wall thickness and stenosis around the terminal ileum, resecting about 90 cm of the ileum, including the stenosis. Macroscopic examination of the resected intestine showed three segmental ulcers and microscopic examination Ul-II ulcers with inflammatory cell infiltration, and fibrosis, mainly in the submucosal layer. An increase in small vessels and reproduction of submucosal epithelium were also seen in the ileum between stenosies. Multiple ulcers and ileum between stenosis apparently formed a continuous region due to the segmental ischemia. No evidence of reoccurrence was seen two years after surgery. Such cases should thus be surgically treated without delay.

Key words
ischemic enteritis, ileus, stenosis

Reprint requests
Seiki Miura Department of General Surgery, Chiba University Graduate School of Medicine
1-8-1 Inohana, Chuo-ku, Chiba, 260-0856 JAPAN

Accepted
June 18, 2008

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