title: Surgery for acute exacerbation of chronic mesenteric ischemia: a case report.
abstract: BACKGROUND
  Chronic mesenteric ischemia (CMI) is a rare disease; however, symptomatic CMI has a risk of acute exacerbation without timely revascularization.
  
  
  METHODS
  A 54-year-old man who had had postprandial pain for 6 months was admitted to our hospital because of vomiting and diarrhea. Although the celiac and superior mesenteric arteries were occluded at the proximal portion, contrast enhancement of the bowel wall was good in contrast-enhanced computed tomography (CECT). Endoscopic examination revealed only a healed gastric ulcer and slight mucosal erosions in the colon. He was diagnosed as having acute enteritis or inflammatory digestive disease and observed with conservative therapy, which improved his acute symptoms. On hospitalization day 42, he suddenly complained of lower back pain. CECT showed abdominal free air, which indicated gastrointestinal perforation. Emergency surgery was performed for jejunum resection. Two days later, a second operation was performed for a leak in the anastomotic site of the jejunum. Necrotic change in the small intestinal serosa was also observed and required broad resection of the small intestine. He was diagnosed with acute exacerbation of CMI, and we performed surgical retrograde bypass to the gastroduodenal artery using a saphenous vein graft as the third operation. After the surgery, he was free from digestive symptoms and was discharged.
  
  
  CONCLUSIONS
  When patients complain of chronic and gradual digestive symptoms, we should always consider symptomatic CMI. Timely mesenteric revascularization is important for symptomatic CMI before severe complications occur.
authors.affiliation: Department of Cardiovascular Surgery, Kin-i-kyou Central Hospital, 5-1-9-1 Higashinaebo, Higashi-ku, Sapporo, 007-8505, Japan. shinabe_mail@yahoo.co.jp.
authors.forename: Shinji
authors.identifier: http://orcid.org/0000-0003-0237-6047
authors.initials: S
authors.lastname: Abe
authors.affiliation: Department of Cardiovascular Surgery, Kin-i-kyou Central Hospital, 5-1-9-1 Higashinaebo, Higashi-ku, Sapporo, 007-8505, Japan.
authors.forename: Tomoji
authors.initials: T
authors.lastname: Yamakawa
authors.affiliation: Department of Surgery, Kin-i-kyou Central Hospital, 5-1-9-1 Higashinaebo, Higashi-ku, Sapporo, 007-8505, Japan.
authors.forename: Hideaki
authors.initials: H
authors.lastname: Kawashima
authors.affiliation: Department of Surgery, Kin-i-kyou Central Hospital, 5-1-9-1 Higashinaebo, Higashi-ku, Sapporo, 007-8505, Japan.
authors.forename: Makoto
authors.initials: M
authors.lastname: Yoshida
authors.affiliation: Department of Surgery, Kin-i-kyou Central Hospital, 5-1-9-1 Higashinaebo, Higashi-ku, Sapporo, 007-8505, Japan.
authors.forename: Setsuji
authors.initials: S
authors.lastname: Takanashi
authors.affiliation: Department of Surgery, Kin-i-kyou Central Hospital, 5-1-9-1 Higashinaebo, Higashi-ku, Sapporo, 007-8505, Japan.
authors.forename: Motoya
authors.initials: M
authors.lastname: Kashiyama
authors.affiliation: Department of Surgery, Kin-i-kyou Central Hospital, 5-1-9-1 Higashinaebo, Higashi-ku, Sapporo, 007-8505, Japan.
authors.forename: Masahiro
authors.initials: M
authors.lastname: Ishigooka
authors.affiliation: Department of Cardiovascular and Thoracic Surgery, Hokkaido University Hospital, Kita-15, Nishi-7, Kita-ku, Sapporo, 060-8638, Japan.
authors.forename: Yasushige
authors.initials: Y
authors.lastname: Shingu
authors.affiliation: Department of Cardiovascular and Thoracic Surgery, Hokkaido University Hospital, Kita-15, Nishi-7, Kita-ku, Sapporo, 060-8638, Japan.
authors.forename: Yoshiro
authors.initials: Y
authors.lastname: Matsui
keywords: Chronic mesenteric ischemia; Surgical revascularization