[Massive entero-mesenteric infarction. A possible role of ostial stenosis of digestive arteries]

Abstract

A case is reported of a 35-year-old woman who sustained a massive intestinal infarction requiring a total resection of small intestine and the colon, with a terminal duodenostomy. Preoperative arteriography and intraoperative findings at laparotomy showed a thrombosis of coeliac trunc, superior and inferior mesenteric arteries, originating possibly from a non atheromatous ostial stenosis of these vessels. The blood supply to stomach, duodenum, liver and spleen was maintained through collaterals from diaphragm. Postoperatively a dehiscence of duodenostomy suture occurred with a spontaneous favourable outcome. The closure of external duodenostomy orifice required an endoscopic aspirational gastrostomy. The patient was discharged with the perspective of intestinal transplantation, her nutrition being provided through an ambulatory parenteral nutritional support unit. A symptomatology of chronic mesenteric ischaemia should lead to an angiography of digestive arteries not only with a diagnostic but also a possible therapeutic goal using angioplasty techniques.