Fibromuscular dysplasia of the visceral arteries

Fibromuscular dysplasia (FMD) commonly involves the renal and carotid arteries. However, visceral arterial involvement is rare. We report a 39-yr-old male who developed ischemic bowel disease twice (once in the jejunal artery and once in the sigmoid artery) as a result of FMD. First ischemic change occurred in the sigmoid colon with manifestation of melena and abdominal pain, and the second occurred in the jejunum, with severe abdominal pain and intestinal stenosis. Angiography revealed the "string of beads" appearance, characteristic of FMD, in those two arteries responsible for the ischemic lesions. Fasting therapy with intravenous hyperalimentation improved both lesions, but secondary stenosis caused by ischemia occurred in the jejunum. Surgical resection of the stenotic jejunum was required. Although the abnormal arteries that had been imaged as a "string of beads" on angiography were not resected, the postoperative course has been uneventful and satisfactory.