Endoscopic suspect of subacute occlusive mesenteric ischemia

Area of Science:

• Gastroenterology
• Vascular Surgery
• Diagnostic Imaging

Background:

• Chronic mesenteric ischemia (CMI) is often caused by atherosclerosis, leading to reduced blood flow in the digestive tract.
• Diagnosis can be challenging due to a paucisymptomatic presentation in many patients, despite classic symptoms like postprandial pain.

Observation:

• A 74-year-old patient presented with melena and epigastric pain, showing endoscopic signs suggestive of ischemia in the stomach and duodenum.
• Abdominal computed tomography angiography (CTA) revealed significant atherosclerotic disease and intestinal wall hypoenhancement, confirming ischemia.

Findings:

• Endoscopic findings including pale mucosa, loss of vascular pattern, and superficial ulcers (Forrest III) in the gastric antrum and duodenal bulb can indicate ischemia.
• CTA is the gold-standard for diagnosing CMI, showing atherosclerotic plaques and compromised intestinal perfusion.
• Exploratory laparoscopy confirmed patchy ischemia affecting both small and large intestines.

Implications:

• Recognizing endoscopic signs of mesenteric ischemia, even in the absence of classic symptoms, can facilitate earlier diagnosis.
• Prompt diagnosis and treatment are crucial for managing mesenteric ischemia and preventing complications.
• Abdominal CTA plays a vital role in confirming the diagnosis and guiding treatment strategies for CMI.