Abstract
The patient was a 66-year-old male who had received maintenance hemodialysis due to diabetic nephropathy since December 1993. On March 21, 2002, he developed left peri-umbilical pain about one hour after supper. The pain gradually intensified, causing him to be emergently hospitalized on March 22. Thereafter, further episodes of similar abdominal pain successively caused four additional admissions. On the last admission, laboratory blood data did not show any inflammatory change, but calcified lesions were demonstrated in the superior and inferior mesenteric arteries (SMA and IMA) by abdominal CT scan. Arteriography produced clear images of the celiac artery and SMA, while in the IMA region, the truncal area was stenosed and its peripheral arterial branches showed poorly visualized areas most likely due to luminal stenosis. There was no thrombus formation observed in any of the above areas. On gastroscopy, barium enema and colonoscopy, there were no abnormal findings. From the above clinical course and laboratory findings, he was diagnosed as having diet-induced abdominal anginal attacks. On arteriography, stenosis in the IMA trunk as well as highly suspected diffuse luminal stenoses in its peripheral branches ruled out the possibility of surgical therapy for anginal disease. After he was discharged, he was prescribed a less strict dry weight control by dialysis in the satellite hemodialysis facility. Because there was ample collateral circulation present between the three major splanchnic arteries, e.g. the celiac artery, superior and inferior mesenteric arteries, most reports on the development of abdominal angina have been restricted to cases of stenotic lesions involving at least two of the three splanchnic arteries. In the present case, abdominal angina was likely to have been caused by chronic ischemia restricted to the IMA region, suggesting that this is a rare case.
