Chronic mesenteric ischemia, an undervalued cause of constitucional syndrome

Abstract

Chronic mesenteric ischaemia (CMI) is a rare gastrointestinal pathology, the prevalence of which varies according to case series. It is caused by reduced flow in the main mesenteric vessels, namely the celiac artery (CA), superior mesenteric artery (SMA) and inferior mesenteric artery (IMA), the most common aetiology being atherosclerosis. Pathophysiologically, there is an increase in collateral vessels between the CA, SMA and IMA, and the patient may be asymptomatic until advanced stages or only show symptoms in situations of increased flow demand, such as ingestion or physical exercise. These characteristics mean that CMI is an underdiagnosed pathology, frequently confused with other clinical entities such as constitutional syndrome and whose delayed diagnosis is associated with high morbidity and mortality.

We present the case of a patient with multiple vascular risk factors who was incidentally diagnosed with CMI during the endoscopic study due to clinical suspicion of constitutional syndrome. However, given the advanced stage of the patient, he finally required hospitalisation and surgery, which shows the importance of early diagnosis of this clinical entity.

Keywords: endoscopy, chronic mesenteric ischemia, constitutional syndrome.