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Intestinal ischemia resulting from Buerger's disease: report of a case
1Second Department of Surgery, Tokyo Medical and Dental University, Japan.
Insights
Buerger's disease, a rare vascular condition, can cause serious intestinal ischemia due to arterial blockages. This case highlights the severe mesenteric vascular complications and successful surgical intervention for intestinal necrosis.
Area of Science:
- Vascular Surgery
- Gastroenterology
- Pathology
Background:
- Buerger's disease is a rare inflammatory vascular condition primarily affecting small and medium-sized arteries, veins, and nerves of the extremities.
- Patients with Buerger's disease often present with critical limb ischemia, necessitating amputations.
- Intestinal ischemia is an uncommon but severe complication of Buerger's disease.
Observation:
- A 42-year-old male with a history of bilateral below-the-knee amputations due to Buerger's disease presented with acute abdominal symptoms.
- Emergency surgery revealed ischemic changes in the cecum and ascending colon, requiring resection.
- Postoperative angiography confirmed occlusions in the superior mesenteric and right external iliac arteries.
Findings:
- Surgical specimens showed mucosal necrosis, ulceration, and significant wall thickening with adhesions in the resected bowel.
- Microscopic examination revealed occluded mesenteric vessels with organized thrombi and recanalization, preserving vascular architecture.
- The patient experienced no further intestinal symptoms one year post-discharge.
Implications:
- This case underscores the potential for Buerger's disease to cause extensive mesenteric arterial occlusive disease leading to intestinal ischemia.
- Early diagnosis and aggressive management of vascular complications are crucial in patients with Buerger's disease.
- Successful surgical management can lead to favorable long-term outcomes even in complex cases of mesenteric ischemia secondary to Buerger's disease.
Abstract:
A 42-year-old man who had undergone below-the-knee amputations for Buerger's disease 9 and 14 years earlier required emergency surgery for intestinal ischemia caused by arterial occlusive lesions in the mesentery. The cecum and proximal part of the ascending colon were resected, and marked hyperemic thickening of the wall and severe fibrous adhesions were found. Postoperative angiography revealed occlusions in the superior mesenteric and right external iliac arteries. The resected specimen showed mucosal necrosis of the cecum and circular ulcers at Bauhin's valve and at the ascending colon. Microscopically, small mesenteric vessels were occluded by organized and recanalized thrombi with preserved vascular architecture. The patient has remained free of any further intestinal symptoms for 1 year following his discharge from hospital.