Case Report: Vascular abdominal pain in systemic sclerosis-chronic mesenteric ischemia from high-grade superior mesenteric artery stenosis with coexisting aortomesenteric narrowing

Gastrointestinal involvement is common in systemic sclerosis (SSc), but severe abdominal pain should not be attributed automatically to dysmotility or malabsorption. We report a 72-year-old woman with long-standing limited cutaneous SSc who developed recurrent severe abdominal pain, progressive oral-intake limitation, and marked weight loss. Abdominal computed tomography angiography showed high-grade calcified stenosis at the superior mesenteric artery (SMA) origin together with a reduced aortomesenteric angle of 17 degrees and a distance of 4.7 mm, creating a coexisting SMAS-like anatomic context. After multidisciplinary review, endovascular balloon angioplasty and stent implantation were performed because the SMA lesion was considered a major treatable vascular contributor in a frail patient at high operative risk. Severe pain improved and oral intake advanced after revascularization, but portal-hypertensive disease, partial small-bowel obstruction, severe malnutrition, and SSc-related gastrointestinal involvement remained plausible concurrent contributors. Follow-up CTA in March 2024 showed post-stent changes without recurrent acute mesenteric ischemia, but long-term stent-patency and nutritional-recovery data were limited. This case does not establish a new causal mechanism; rather, it illustrates a structured approach to severe abdominal pain in SSc that distinguishes a treatable vascular lesion from SMAS-like anatomy and other nonvascular abdominal disease.