A Case of Protein-losing Gastroenteropathy after Superior Mesenteric Artery Occlusion in which Intraoperative Endoscopy was Effective

Abstract

Although protein-losing gastroenterolpathy can occur by a variety of causes, it is rare that the disease occurs after treatment of superior mesenteric artery occlusion. We present a case of protein-losing gastroenteropathy which developed after conservative therapy for superior mesenteric arterial occlusion and was relieved by bowel resection.

A 73-year-old man presenting with epigastric pain was diagnosed with superior mesenteric artery occlusion by close examination and received conservative treatment. Oral ingestion was resumed after disappearance of blood occlusion, but abdominal pain and diarrhea persisted and hypoalbuminemia and general edema progressed. Because α1 antitrypsin level in stool was high, protein-losing gastroenteropathy was diagnosed. Despite nutritional therapy, no remission was gained and the upper part of the jejunum to where radio-labeled albumin accumulation was confirmed by ^99mTc-human serum albumin (HSA) scintigraphy was resected. By using intraoperative endoscopy, we confirmed ulcer formation on the mucosal surface of the upper jejunum and resected all areas involving ulcers. After the surgery, abdominal symptoms disappeared and hypoalbuminemia improved as well. Protein-losing gastroenteropathy after conservative therapy for superior mesenteric artery occlusion can be relieved by surgery, however, intraoperative endoscopy is useful to decide resection areas.