1Sreenath Sethumadhavan, 1Tushar Suvra Ghosh, 1Pawan Kumar Garg, 1Pushpinder Singh Khera
1All India Institute of Medical Sciences, Jodhpur, India
At a time when endovascular treatment is increasingly being regarded as the first-choice treatment for chronic mesenteric ischemia (CMI), we describe a case of reperfusion injury, an uncommon complication following endovascular superior mesenteric artery (SMA) stenting for CMI.
Material(s) and Method(s):
We present a patient with post prandial abdominal pain and weight loss for 10 months, with CT abdominal angiography showing complete occlusion of celiac axis and 70-80% stenosis of proximal superior mesenteric artery and 80-90% stenosis of ostio-proximal inferior mesenteric artery. He was taken up for endovascular stenting of SMA, the procedure went well with no intra and periprocedural complication.
He developed abdominal distension, limb edema and bleeding per rectum within the next few days. Blood investigations revealed fall in haemoglobin and serum albumin. Repeat CT angiography revealed that the stent was patent and there was presence of ascites with bowel wall edema and hyperemia.
Patient was managed conservatively with complete resolution of symptoms in next 10 days.
The above symptoms and imaging findings may be attributed to reperfusion injury of the bowel due to restoration of blood flow after prolonged ischemia. Reperfusion syndrome is an entity more commonly described following treatment of carotid stenosis and peripheral arterial occlusion. Limited literature is available of reperfusion syndrome following endovascular revascularisation of CMI.
Reperfusion injury can present with symptoms ranging from mild abdominal pain to multi organ failure or severe inflammatory response syndrome. The risk of reperfusion is more if stenosis is severe, prolonged ischemia and all the vessels are diseased.
Reperfusion injury is a rare but significant complication of revascularisation following CMI. Knowledge of reperfusion injury is important to differentiate between other relatively common complications like stent thrombosis/occlusion and mesenteric arterial injury leading to hemoperitoneum.