Intestinal Ischemia as a Single Manifestation of Thromboangiitis Obliterans

Abstract

Thromboangiitis obliterans (TAO) is an inflammatory, nonocclusive, and nonatherosclerotic vascular disease. It commonly affects arteries, veins, and surrounding neural elements and is directly related to smoking. Although distal vessels of lower and upper extremities are the most commonly involved, other vessels such as intestinal arteries can be rarely affected. The authors describe a 41-year-old white male smoker who presented with abdominal pain for 3 months and developed an acute bowel ischemia. He underwent urgent surgery, and segmental enterectomy was performed. Histopathologic findings were suggestive of TAO, showing typical involvement of small-sized veins and arteries with intact internal elastic lamina, preserved media, a local nonspecific inflammatory reaction, with new and older arterial and venous thromboses associated. Although mesenteric arteries are seldom injured by TAO, this diagnosis must be considered when the usual causes of intestinal ischemia are ruled out. In this case, even without any other clinical symptoms of TAO, this rare diagnosis could be made.

Leucocytosis and type 2 diabetes mellitus – a case report

“…3 Sympathectomy may be helpful in pain relief as a short term solution, but this method has not proved to have any benefits in treating the disease. 4 Aspirin and clopidogrel may be efficient in preventing secondary events, but here is no evidence, however, to suggest that the symptoms of claudication are reduced by long-term treatment. 5 Abstinence from smoking is the only definitive treatment to prevent disease progression.…”

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“…As it did with our patient, the disease usually begins with involvement of the distal small arteries and veins, resulting in ischemia. Although TO most commonly remains a disease of small‐ and medium‐sized arteries and veins in the extremities, there are case reports describing the disease in many other vascular beds (2–6). There are no specific laboratory tests that are indicative of TO, although, as in this patient's case, an elevated ESR can indicate active inflammation and tissue damage.…”

Colon Ischemia Associated with Buerger's Disease: Case Report and Review of the Literature

“…However, in a few cases with unusual onset of the disease, typical findings of pathology would be needed. 12 In acute phase, there is acute inflammation involving all layers of the vessel wall in association with occlusive cellular thrombosis. In the subacute phase, there is progressive organization of the occlusive thrombus in the arteries and veins, and the chronic phase is characterized by complete organization of the occlusive thrombus with extensive recanalization, prominent vascularization of the media and adventitial and perivascular fibrosis.…”

“…12 Until now, twenty nine case reports were published in the world. 6,12,18,19 It may occur at any time during the course of the disease, but mostly it happens years after the onset of the disease.…”

“…12 Until now, twenty nine case reports were published in the world. 6,12,18,19 It may occur at any time during the course of the disease, but mostly it happens years after the onset of the disease. 6,16 However, most reported cases had significant peripheral vascular manifestations before developing mesenteric involvement.…”