Year 2022 / Volume 114 / Number 11
Letter
Endoscopic suspect of subacute occlusive mesenteric ischemia

689

DOI: 10.17235/reed.2022.8857/2022

Patricia Sanz Segura, María Pérez Millán, Yolanda Arguedas Lázaro, Juan Manuel Nerín de la Puerta, Juan José Sebastián Domingo,

Abstract
A 74-year-old patient presented to our emergency department with melena for 24 hours, associated with postprandial abdominal pain, predominantly in the epigastrium, for one month. Urgent gastroscopy showed a pale mucosa with loss of vascular pattern in the gastric antrum, as well as several superficial ulcers, Forrest III, at that level and in the duodenal bulb highly suggestive of ischaemia. An abdominal computed tomography angiography (CTA) revealed a filiform celiac trunk, with calcified atherosclerotic plaques in the ostium, superior mesenteric artery and both renal arteries, with absence of enhancement in a large part of the intestinal wall, suggestive of ischaemia. An exploratory laparoscopy confirmed patchy ischaemia of the small intestine, as well as of the cecum, ascending colon, and portion of the transversus. Atherosclerosis is the most common cause of occlusive chronic mesenteric ischaemia. The ‘classic triad’ consisting of postprandial pain, weight loss and abdominal bruit, is found in only a minority of patients, with a significant percentage of paucisymptomatic patients due to abundant colateral circulation, making diagnosis difficult. The endoscopic finding of edema, erythema or signs of mucosal atrophy, as well as gastric or duodenal ulcers, not justified by other causes can guide us in the diagnosis. However, more distal sections of the digestive tract which are not accessible with the conventional endoscope can often be affected, and the absence of these findings, does not exclude the diagnosis. Abdominal CTA is the gold-standard imaging test. Early diagnosis of mesenteric ischaemia is a challenge in clinical practice. Recognizing its endoscopic signs can facilitate its early diagnosis and treatment.
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Sanz Segura P, Pérez Millán M, Arguedas Lázaro Y, Nerín de la Puerta J, Sebastián Domingo J. Endoscopic suspect of subacute occlusive mesenteric ischemia. 8857/2022


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Publication history

Received: 11/04/2022

Accepted: 12/04/2022

Online First: 12/05/2022

Published: 07/11/2022

Article Online First time: 31 days

Article editing time: 210 days


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