Chronic small bowel ischemic protein losing enteropathy
Elderly male a known case of ischemic heart disease, presented with chronic diarrhea (1 month) with lower abdominal cramps. The patient has occult blood in stool, reticulocytosis and low serum protein (5.5 g/dL). Endoscopic biopsy has ruled out inflammatory bowel disease as a cause.
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Regular, asymmetric, enhancing, edematous, long segment ileal wall thickening without significant luminal compromise. There is surrounding fat stranding and intraperitoneal free fluid.
In addition there is significant circumferential plaque deposition noted in the intema of abdominal aorta distal to the origin of celiac trunk with significant stenosis (4 mm) of superior mesenteric artery at origin.
In view of clinical features and pathological findings like; occult blood in stool, low serum protein (5.5 g /dL) with normal albumin/globulin ratio; imaging findings are suggestive of chronic ischemic ileitis with protein losing enteropathy.
Mesenteric ischemia is not a common rather a rare cause of protein losing enteropathy so it should be considered as a diagnosis of exclusion.
Previous ultrasound of this patients has indicated non specific ilieitis and patient had undergone for endoscopy and biopsy which ruled out inflammatory bowel disease. After 15 days of continued symptoms this CT was done and showed narrowing of superior mesenteric artery at the origin and retrospective dulplex scan showed high velocity flow (>300 cm/sec) at the stenosed part of SMA origin which signifies meseteric ischemia.
- 1. Thompson JF, Levy J, Stolar CJ, Wigger HJ. Protein-losing enteropathy in prolonged post-ischemic ileitis. Journal of pediatric gastroenterology and nutrition. 5 (3): 504-7. Pubmed