A case of ischemic stenosis of the small intestine associated with ischemic colitis of the sigmoid colon

Abstract

A 59-year-old male complaining of abdominal pain was admitted to our hospital with a diagnosis of intestinal obstruction and underwent conservative therapy. Melena occurred on the 2nd hospital day and emergency colonoscopy revealed ischemic changes of the sigmoid colon. Ischemic colitis of the sigmoid colon was diagnosed and the conservative therapy was resumed. Temporary symptomatic remission was gained, but restarting diet induced abdominal pain and abdominal distension again. Abdominal x-ray film showed small intestinal obstruction, so that a long tube was inserted. Abdominal CT scan showed thickened wall of the small intestine, but his symptoms subsided and he was discharged from the hospital on the 30th hospital day. However lower abdominal pain recurred, and he was readmitted to the hospital and underwent laparotomy on the 7lst day after the onset of the symptom. At the operation, the small intestine about 15 cm in length and about 150 cm distant from the Treitz'ligament was flared up and firm, but no signs of embolization were observed at the mesentery. A 60cm-long portion of the small intestine including the edematous portion was resected. The resected small intestine revealed thickened wall with redness and fibrosis in the submucosal layer microscopically, and it was diagnosed as ischemic enteritis.
We report a rare case of ischemic stenosis of the small intestine associated with ischemic changes of the sigmoid colon.