Mesenteric arterial steal syndrome secondary to bilateral lumbar sympathectomy

A case of acute mesenteric ischemia and massive intestinal infarction secondary to bilateral lumbar sympathectomy and without any other apparent precipitating factors is presented. Its characteristics and findings significantly agree with those described as part of the mesenteric arterial steal syndrome. Although this syndrome was originally described as secondary to surgical revascularization of the lower extremities, experimental studies have shown that lumbar sympathectomy, by means of reducing the peripheral vascular resistance in the lower extremities, similarly causes intense hemodynamic alteration of the mesenteric circulation due to the sudeen redistribution of blood flow to the lower limbs at the expense of the mesenteric flow. When marginally compensated occlusive mesenteric arterial disease exists prior to surgery, the sudden fall in the arterial pressure gradients in this vessel can precipitate the occlusion of these arteries, resulting in mesenteric ischemia and intestinal infarction. It has also been suggested that an intense vasospamodic neurogenic reflex in the mesenteric arteries is an important factor in the pathogenesis of this syndrome.