Title:
Chronic Mesenteric Ischemia Secondary to Atherosclerosis with Concomitant Median Arcuate Ligament Syndrome: A Tale of Two Stories

Authors:
Abrar Zaki, Leslie Bahn Kawa, UK

Abstract:

Background:

Abdominal pain is a common acute medical and /or surgical presentation to the emergency departments with myriad causes. Mesenteric angina secondary to mesenteric atherosclerosis is the most common cause while median arcuate ligament syndrome is a rare one. However, there are no reports of simultaneous occurrence of both etiologies in patients with mesenteric angina.

Clinical Case:

We describe a case of chronic mesenteric ischemia in a 53-year-old female patient who has had partial colectomy for Crohn’s diseases with ligation of the inferior mesenteric artery. She presents with severe chronic intermittent post-prandial abdominal pain associated with nausea, vomiting and a 10% weight loss in addition to chronic persistent hyperlactatemia.

She was found to have an atherosclerotic plaque of the superior mesenteric artery associated with a concomitant median arcuate ligament. The diagnosis was made after abdominal angiogram with a successful angioplasty of the superior mesenteric artery.

Conclusion:

Mesenteric angina can be caused by either atherosclerosis and/or median arcuate ligament syndrome. It is rare to diagnose both simultaneously in patients with mesenteric angina. When you do, treatment should be tailored towards the highly possible etiology. In this case, mesenteric angina was successfully treated with angioplasty of the superior mesenteric artery.

DOI: http://dx.doi.org/10.51505/ijmshr.2024.8609