Intestinal thromboangiitis obliterans: a case report.

Area of Science:

• Vascular Surgery
• Gastroenterology
• Internal Medicine

Background:

• Thromboangiitis obliterans (Buerger's disease) is a peripheral vascular disease predominantly affecting young male smokers.
• Intestinal involvement is rare (2%), often presenting as acute abdomen due to mesenteric ischemia.
• Delayed diagnosis of intestinal Buerger's disease increases morbidity and mortality.

Observation:

• A young male smoker with a history of lower extremity amputation presented with acute abdominal pain, vomiting, and diarrhea.
• Initial surgery revealed an omental band and dilated bowel loops; appendectomy was performed.
• Postoperatively, the patient developed an enterocutaneous fistula, jejunal perforations, and complications from gastrojejunostomy and feeding jejunostomy.

Findings:

• The patient experienced multiple surgical interventions including jejunal resection and bypass procedures.
• Despite aggressive management, the patient developed septicemia and refractory septic shock.
• The patient ultimately succumbed to complications of the disease and its treatment.

Implications:

• Acute abdomen in young smokers with a history of non-traumatic amputation should raise suspicion for intestinal Buerger's disease.
• Early recognition of intestinal Buerger's disease is vital for potentially salvaging the patient and reducing complications.
• Smoking cessation is critical for managing Buerger's disease, though visceral involvement may progress despite cessation.