Diarrhoea caused by a stenosis of the coeliac artery: suggestive for mesenteric steal

Abstract

The classical triad of postprandial pain, weight loss and an abdominal bruit is thought to be the most common presentation of chronic gastrointestinal ischaemia. We describe a patient with severe diarrhoea as an uncommon presenting symptom of small bowel ischaemia, suggesting a mesenteric steal phenomenon due to a significant atherosclerotic coeliac artery stenosis. The stenosis and concomitant steal effect was successfully treated by stent placement. The latter is supported by the patient's uneventful course after stent placement. This case illustrates that chronic gastrointestinal ischaemia has to be considered in patients with otherwise unexplained diarrhoea.

Figure 1

(A) Abdominal angiography: selective injection of contrast in the coeliac artery, showing a significant atherosclerotic stenosis. (B) Abdominal angiography: stent placement in the origin in the coeliac artery.

Figure 2

24 h tonometry: postprandial jejunal ischaemia with repeated pathological postprandial CO₂ peaks rising to 15.9 kPa; normal gastric measurements (no ischaemia). Normal values CO₂ maximal 10.6–13.6 kPa varying after different meals. Y axis: CO₂ in kPa. X axis: Time in hours.