Abstract
We report a case of ileus and acute superior mesenteric arterial (SMA) occlusion in an 89-year-old woman, who was referred to surgical department because of continuing symptoms of ileus and exacerbation of abdominal pain. Abdominal CT showed obstruction of SMA and ischemia of intestine. We performed emergency surgery and resection of necrotic intestine. Pathological examination revealed that SMA was occluded by thrombosis and medium/small-sized vessel wall was destroyed with fibrinoid necrosis and infiltrated by inflammatory cells. Hematological examination showed CRP and MPO-ANCA positive. Therefore, we made the diagnosis of ileus and SMA occlusion caused by ANCA-associated vasculitis.
It is extremely rare that vasculitis cause SMA occlusion. We should suspect vasculitis in the case of continuous abdominal pain and ileus of uncertain origin. It may prevent severe disease.
