The angiographic appearance of thromboangiitis obliterans (Buerger's disease) in the abdominal visceral vessels

Intestinal involvement in Buerger's disease

Thromboangiitis obliterans characteristically affects small- and medium-sized vessels of the limbs in young smokers. There is some controversy about the existence of visceral localizations of the disease. The case of a patient with a well-established diagnosis of thromboangiitis obliterans who presented with mesenteric ischemia is described and the literature concerning mesenteric involvement in the disease is reviewed.

[Buerger's disease disclosed by a perforation in the digestive system. Apropos of a case and review of the literature]

A 27 year-old man who underwent an intestinal segmental resection for small bowel perforation was hospitalized for chronic abdominal pain with weight loss. Coeliac and mesenteric stenosis was diagnosed and laparotomy was performed. Histologic findings were consistent with Buerger's disease. One month later, he developed intermittent claudication of the left leg, and 8 years later amputation of a toe was performed. Since 1956, 25 cases of abdominal Buerger's disease has been reported in the literature. In eight cases, intestinal involvement inaugurated the disease. The clinical presentation can be various: chronic abdominal pain, mesenteric infartus, occlusion, perforation. Small bowel, colon and rectum can be concerned. The literature points out a mortality rate of 25% in intestinal Buerger's disease, contrasting with a mortality rate of 4% in peripheral forms of the disease. Although rare, intestinal form of Buerger's disease should be diagnosed early, because of its high mortality rate. Doppler of mesenteric arteries may contribute to the early diagnosis.

Intestinal type of thromboangiitis obliterans (Buerger's disease)

Thromboangiitis obliterans (TAO) is a recurrent, inflammatory, segmental occlusive disease of distal limb arteries which may involve veins as well. Young smokers are predisposed to TAO. The intestinal vessels are rarely affected. We report the clinical, angiographic and histologic findings of a 23-year-old smoker with extended thrombophlebitis who developed severe abdominal angina and liver hypoxia due to occlusion of the coeliac artery and subtotal occlusion of the superior mesenteric artery. Two surgical bypassing procedures were followed by early graft occlusion. Subsequently, a plastic patch of the superior mesenteric artery and an aortohepatic bypass were performed. The literature since 1945 pertinent to intestinal TAO is reviewed.

Intestinal ischemia resulting from Buerger's disease: report of a case

A 42-year-old man who had undergone below-the-knee amputations for Buerger's disease 9 and 14 years earlier required emergency surgery for intestinal ischemia caused by arterial occlusive lesions in the mesentery. The cecum and proximal part of the ascending colon were resected, and marked hyperemic thickening of the wall and severe fibrous adhesions were found. Postoperative angiography revealed occlusions in the superior mesenteric and right external iliac arteries. The resected specimen showed mucosal necrosis of the cecum and circular ulcers at Bauhin's valve and at the ascending colon. Microscopically, small mesenteric vessels were occluded by organized and recanalized thrombi with preserved vascular architecture. The patient has remained free of any further intestinal symptoms for 1 year following his discharge from hospital.