Clinical analysis and literature review of a complicated superior mesenteric artery stenosis with intestinal necrosis: A case report

Medicine · 6 authors, 6 centres

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TL;DR

This case report describes a 64-year-old male with complicated superior mesenteric artery stenosis who underwent endovascular stenting but developed intestinal necrosis requiring surgical resection. The case highlights the importance of considering multiple causes of abdominal pain, not just vascular disease.

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This is a case report of a 64-year-old male admitted with abdominal pain, diagnosed with superior mesenteric artery stenosis via CT angiography. Initial endovascular treatment with balloon dilatation and self-expanding bare stent implantation relieved symptoms, but stent migration and restenosis occurred, leading to a second balloon-expandable stent placement. Persistent postprandial pain led to laparotomy, which revealed intestinal necrosis and fistula due to adhesions from prior surgery, necessitating ileocecal resection and enterolysis. A 9-month follow-up CT angiography showed patent stents and favorable prognosis. The case underscores that abdominal pain in the context of mesenteric ischemia may have concurrent causes like adhesions, requiring integrated assessment and timely intervention.

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case_report

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surgery

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100% · A

ORIGINAL PAPER

PMC10145880

Clinical analysis and literature review of a complicated superior mesenteric artery stenosis with intestinal necrosis: A case report

Medicine

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ABSTRACT

Rationale: Superior mesenteric artery (SMA) stenosis, as a common arterial disease, if coexists with other possible causes of abdominal pain, is complicated, which may require not only conservative treatment but also surgical intervention. Patient concerns: A 64-year-old male patient who was admitted to our hospital with pain located around the umbilicus and right lower quadrant for 12 hours. Diagnosis: SMA stenosis was initially diagnosed. After balloon dilatation of SMA and stent implantation, computed tomography angiography reexamination showed that the stent was migrated and the stenosis reoccurred. During the ileocecal resection and enterolysis, the necrotic bowel was found and cut open, and the intestinal fistula was found. Combined with his abdominal surgery history, the patient was diagnosed with complicated SMA stenosis with intestinal necrosis. Interventions: The balloon dilatation of SMA and stent implantation was performed. Because the stent was migrated and the stenosis reoccurred, so a balloon stent was implanted in the proximal stenosis of SMA again. The patient’s symptoms were relieved and reoccurred again. The ileocecal resection and enterolysis were performed. Outcomes: The computed tomography angiography showed that the stents were well deployed and unobstructed after 9 months follow-up. Lessons: When dealing with undetermined abdominal pain that especially has something to do with mesenteric artery ischemia, if there coexists with other possible causes of abdominal pain, we cannot only focus on vascular diseases. We should be vigilant, integrate multiple factors and their interactions to guarantee the accuracy and timeliness of diagnosis and therapy.

CITATION EXPORT

Binbin Zhou, Junjie Huang, Xiaobin Chen et al.. Clinical analysis and literature review of a complicated superior mesenteric artery stenosis with intestinal necrosis: A case report. Medicine. (2023). https://doi.org/10.1097/MD.0000000000033586

AUTHORS

6 · 6 CENTRES

Binbin Zhou, Junjie Huang, Xiaobin Chen, Chen Lin, Yin Xia, Rong Jiang

a Fuzong Clinical Medical College, Fujian Medical University, Fuzhou, China
b Fujian University of Traditional Chinese Medicine, Fuzhou, China
c Department of General Surgery, 900th Hospital of Joint Logistics Support Force, Fuzhou, China
d Dongfang Hospital, Xiamen University, Fuzhou, China
e Fujian Provincial People’s Hospital, Fuzhou, China
f Department of Vascular Surgery, the Affiliated People’s Hospital of Fujian University of Traditional Chinese Medicine, Fuzhou, China.