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Multimodality Diagnosis of Mesenteric Ischemia
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[Advanced abdominal angina due to atherosclerosis with atypical celiac arteries]

M Makowski1, J Bartlewicz, M Krzanowski

  • 1II Katedra Chorób Wewnetrznych, Collegium Medicum Uniwersytetu Jagiellońskiego w Krakowie.

Polskie Archiwum Medycyny Wewnetrznej
|June 27, 2001
PubMed

Insights

Abdominal angina can occur with only one obstructed splanchnic vessel, challenging the two-vessel obstruction theory. This case highlights anatomical variations and collateral insufficiency in causing severe symptoms.

Area of Science:

  • Vascular Surgery
  • Gastroenterology
  • Anatomical Pathology

Background:

  • Abdominal angina is typically associated with critical obstructions in at least two of the three major splanchnic arteries.
  • This understanding often overlooks the impact of anatomical variations in visceral blood supply.

Observation:

  • A 40-year-old male with arteriosclerosis presented with postprandial pain and isolated superior mesenteric artery (SMA) occlusion.
  • Celiac trunk (CT) and inferior mesenteric artery (IMA) were patent, with no evidence of systemic disease, neoplasm, or malabsorption.

Findings:

  • Arteriography confirmed SMA occlusion, patent CT and IMA, and an atypical origin of the middle colic artery from the CT.
  • A critical lack of collateral circulation between the IMA and SMA was identified as the cause of symptomatic abdominal angina.

Implications:

  • This case demonstrates that abdominal angina can manifest with a single splanchnic artery occlusion if collateral pathways are insufficient.
  • It underscores the importance of considering anatomical variants in diagnosing visceral artery insufficiency.
  • Surgical revascularization effectively resolved the patient's symptoms, validating the diagnosis and treatment approach.

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