A case of protein-losing gastroenteropathy presented with superior mesenteric arterial occlusion

Abstract

A 71-year-old woman who was seen at the hospital because of abdominal pain, vomiting and bloody stool was diagnosed as having superior mesenteric arterial occlusion without associating with intestinal necrosis based on close exploration. Anticoagulation therapy was started and symptomatic remission was noted, however, hypoalbuminemia was exacerbated that necessitated frequent administration of albumin preparations. From examinations including small bowel endoscopy and protein-losing scintigraphy, protein-losing gastroenteropathy from the small intestine was diagnosed. An about 200-cm long portion of the intestine involving from the central portion of the small intestine to the ascending colon was removed. Defluxion of the normal mucosa was observed over a wide area of the removed intestine, at where fur adhered and multiple circular ulcers were observed as well. After the operation serum albumin level was normalized.
Superior mesenteric arterial occlusion is associated with serious intestinal necrosis that may be fatal in not a few cases, but it can be cured conservatively. It is rare that protein-losing gastroenteropathy occurs after the conservative therapy, and our case is the third report in Japan. In our case emergent massive resection of the intestines could be avoided because the cause was etiologically considered to be due to necrosis of mucosa alone, however, associated protein-losing gastroenteropathy demanded intestinal resection.