Young man, cigarette smoking and abdominal pain: Mesenteric involvement of Buerger′s disease

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Jing-Jim Ou and Sheng-Lei Yan

Show Chwan Memorial Hospital, Taiwan

: J Liver Disease Transplant

Abstract

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Buerger’s disease, known as thromboangiitis obliterans, is a progressive, non-arteriosclerotic, inflammatory disease occurring in male smokers younger than 40-50 years of age. Thromboangiitis obliterans predominantly produces occlusion of small to medium-sized vessels of upper and lower extremities. Intestinal involvement of thromboangiitis obliterans is rare. We report a case of 32-year-old male cigarette smoker who had prior history of thromboangiitis obliterans of lower limbs and presented at our institution due to acute abdominal pain. Physical exam revealed diffuse, tender abdomen with diminishing bowel sound. Digital rectal exam found blood in feces. With a high index of suspicion for mesenteric ischemia, emergent surgery was arranged. Bowel infarction was diagnosed by diagnostic laparoscopy and was managed successfully with bowel resection. Thromboangiitis obliterans with mesenteric vascular involvement was confirmed by pathological examination. The literature concerning mesenteric involvement of thromboangiitis obliterans is reviewed. In most reported cases, mesenteric involvement of Buerger’s disease occurred after the disease had affected lower extremities. Mesenteric involvement has been the initial clinical manifestation of Buerger’s disease in one reported case. If a young male with habit of cigarette smoking presented ischemic abdominal pain, especially with history of Buerger's disease, mesenteric involvement of Buerger's disease should be a part of differential diagnosis.

Biography

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Jing-Jim Ou has his expertise in Minimal Invasive Surgery in the field of Colon and Rectal Disease. He completed Surgical Residency training at Tri-Service General Hospital and then worked as an attending Surgeon at Show Chwan Memorial Hospital. In 2010, he completed his fellowship training at IRCAD in Strabourg. With the experience of Minimal Invasive Surgery, he also worked as one of the local Faculty at Asian Institute of Tele-Surgery.