Abstract
An 81-year-old woman was admitted to the hospital because of right upper abdominal pain and melena. Bleeding from the small intestine was suspected as a cause of melena, because we could not detect any bleeding lesion by gastrointestinal fiberscopy and total colonofiberscopy.
The patient appeared systemically well, and was treated conservatively. On the 47th day after the onset of symptoms, the patient exhibited symptom of ileus. Barium-meal studies revealed a long stricture about 30cm in length of the jejunum 25cm distal to the Treitz ligament, Angiography from the superior mesenteric artery (SMA) showed obstruction of major branches of SMA. Despite adequate hyperalimentation, the patient presented remarkable hypoalubuminemia. Extravasation was seen in the strictured jejunum by 99mTc-labeled albumin scintigraphy. So, we diagnosed the case as ischemic stricture of the jejunum with protein-losing enteropathy.
A partial resection of small intestine was carried out on 99th day after the onset, the resected jejunnum showed firm tubular stricture 33cm in length, with ulceration (UL-II) and fibrosis. These features were strongly suggestive of an ischemic process.
It is rare that ischemic stricture of the jejunum causes protein-losing enteropathy. This rare case in which extravasation of protein was successfully demonstrated on imaging procedure is reporoted here.
