[Chronic mesenteric ischemia with consecutive ischemic colitis. Suggestions for diagnosis and therapy].
The incidence of acute mesenteric ischaemia has decreased over the last few years. However, cases of chronic mesenteric ischaemia have grown in number, as this disease is the most frequent disorder of the large intestine in the elderly. The typical clinical presentation of ischaemic colitis develops gradually and only becomes recognisable in the late stage of the disease. We present a 51-year-old woman with a history of unexplained abdominal pain. Multislice CT demonstrated an irregular stenosis of the truncus coeliacus and superior mesenteric artery. A Riolan's anastomosis was present and showed excellent perfusion. After a hemicolectomy 6 years previously, different radiologic procedures and endoscopy revealed a structural tumour at the colon transversum we suspected to be malignant. A sequential procedure was conducted. In a first vascular intervention, the truncus coeliacus was reconstructed with a vein patch, and the mesenteric superior artery was replanted. The second laparotomy was performed for revision of the superior mesenteric artery and resection of the intestinal tumour. However, no carcinoma was found in histological examination. In fact, the individual multidisciplinary considerations play an important role in determining the best treatment strategy, if intervention is warranted. Based on our experience, sequential intervention with a common clinical pathway is the safest and most suitable and economic procedure for curing complex pathologies.
Wilke
R
R
Klinik für Allgemein- und Viszeralchirurgie, Klinikum Krefeld gGmbH, Lutherplatz 40, 47805 Krefeld. ralf.wilke@klinikum-krefeld.de
Hutmacher
J
J
Nowak
T
T
Schmidt
W U
WU
D015901:Angiography, Digital Subtraction; D001706:Biopsy; D019917:Blood Vessel Prosthesis Implantation; D002445:Celiac Artery / Q000000981:diagnostic imaging / Q000601:surgery; D002908:Chronic Disease; D003082:Colectomy; D017091:Colitis, Ischemic / Q000175:diagnosis / Q000000981:diagnostic imaging / Q000473:pathology / Q000601:surgery*; D003106:Colon / Q000473:pathology; D003108:Colonic Diseases / Q000000981:diagnostic imaging / Q000473:pathology / Q000601:surgery; D003113:Colonoscopy; D003937:Diagnosis, Differential; D005260:Female; D006801:Humans; D007415:Intestinal Obstruction / Q000000981:diagnostic imaging / Q000473:pathology / Q000601:surgery; D008279:Magnetic Resonance Imaging; D017538:Mesenteric Artery, Superior / Q000000981:diagnostic imaging / Q000601:surgery; D008641:Mesenteric Vascular Occlusion / Q000150:complications* / Q000000981:diagnostic imaging / Q000473:pathology / Q000601:surgery; D008875:Middle Aged; D012086:Reoperation; D036542:Tomography, Spiral Computed