A Case of Ischemic Duodenitis Associated with Superior Mesenteric Artery Syndrome Caused by an Abdominal Aortic Aneurysm

Abstract

A 74-year-old woman was admitted to our hospital with upper abdominal pain and bloody vomiting. An abdominal aneurysm compressed the third portion of the duodenum and the second portion of duodenum was distended with thickened walls as in superior mesenteric artery syndrome. Endoscopic examination showed an edematous mucosa with hemorrhagic erosions, shallow longitudinal ulcers, and star-shaped ulcers in the duodenum. We diagnosed this case as ischemic duodenitis associated with superior mesenteric artery syndrome caused by compression by an abdominal aortic aneurysm. The symptoms improved on treatment with bowel rest, total parenteral nutrition and administration of a proton pump inhibitor. We present here a rare case of ischemic duodenitis and summarize the previous medical literature on the disease.

Upper Gastrointestinal Bleed Secondary to Duodenal Ischemia

“…While the most common cause of chronic mesenteric ischemia impacting the celiac axis or superior mesenteric artery is atherosclerotic disease, AMI is most commonly the result of superior mesenteric artery embolization, superior mesenteric artery thrombosis, non-occlusive mesenteric ischemia, or acute mesenteric venous thrombosis which does not typically affect the duodenum [5]. Duodenal ischemia has been reported in the literature secondary to occlusive disease, abdominal aortic aneurysms, complications of percutaneous endoscopic gastrostomy tube placement, endoscopic retrograde cholangiopancreatography, and transarterial chemoembolization [6]. However in this case, the patient's operative/postoperative course was complicated by hypotension leading to duodenal mucosal ischemia from hypoperfusion.…”

Imaging of non-neoplastic duodenal diseases. A pictorial review with emphasis on MDCT

“…Ischemic duodenitis, caused by splanchnic arterial insufficiency, is very rare because the duodenum has a rich collateral blood supply. Ischemic duodenitis is observed only when at least two of three main splanchnic arteries are occluded or severely stenosed with severe atheromatous disease [ 24 ]. At CT, one can see segmental thickening of the duodenal wall and a lack of mucosal enhancement; submucosal haemorrhage or hyperaemia can also be present.…”

Ischemic Duodenitis with Delayed Elevation of Pancreatic Enzymes

“…Her pain ceased within two days; however, her pancreatic enzyme levels remained elevated for three months. Ischemic duodenitis is very rare because the duodenum is supplied by both the celiac and superior mesenteric arteries ( 1 , 2 ). Once this occurs, clinicians should consider the possibility that the minor and/or major papillae are affected.…”