Successful Surgical Resection for Protein-Losing Enteropathy Caused by Ischemic Ileitis

Protein-losing enteropathy (PLE) is a condition characterized by the excessive loss of serum proteins through the gastrointestinal mucosa, which causes hypoalbuminemia and edema. Common causes include inflammatory diseases, neoplastic diseases, lymphatic diseases, and cardiac diseases. However, cases of PLE caused by small bowel ischemia and cured by surgical resection are rare. Herein, we report a case of PLE caused by ischemic ileitis that was successfully treated by surgical resection.

A 76-year-old woman presented with diarrhea and edema. She had cardiovascular disease and had undergone an ileocecal resection for cecal cancer 15 years ago. Laboratory tests revealed severe hypoalbuminemia without hepatic or renal dysfunction. A contrast-enhanced CT scan revealed edema and panniculitis in the terminal ileum. Technetium-99m-labeled human serum albumin scintigraphy revealed focal protein leakage in the terminal ileum. We diagnosed the patient with PLE caused by ischemic ileitis, and conservative treatment was ineffective, so we performed a resection of the terminal ileum and created an ileostomy. Histopathological examination revealed mucosal erosions, ulcers, and submucosal fibrosis consistent with ischemic ileitis. No malignancy was found. After surgery, serum albumin levels normalized over time, and the patient was discharged after ilieostomy closure.

Ischemic ileitis may lead to PLE, particularly in patients with underlying vascular risk factors. Surgical resection may be effective when the causative lesion is localized and conservative treatment is unsuccessful.