Presentation
Known case of Takayasu arteritis, with acute abdominal pain
Patient Data
Thoracic CT angiography shows normal-appearing aortic arch, ascending and descending aorta, major arch branches, and pulmonary arteries. Pneumomediastinum is due to a recent intervention.
Abdominal CT angiography depicts occlusion of the proximal celiac trunk, SMA and IMA in a length of about 2 cm. Blood supply distal to occluded segments supplied via collateral circulation. Short segment stenosis of infrarenal abdominal aorta and about 50% stenosis at the origin of the right renal artery are seen too. A short flap-like structure is seen at aortic bifurcation.
Considering normal thoracic aorta, and involvement of abdominal aorta and its branches in a middle-aged woman, the findings could be suggestive of type 4 Takayasu arteritis if the diagnosis had been established.
Considering the above CT scan findings, vascular bypass surgery was scheduled, after the surgery patient again underwent a CT scan, which presents in the box below, because of generalized abdominal pain.
An unusual vascular structure is visible that connects the patent SMA after the occluded segment to the right common iliac artery.
Two stomas have been sited, which both are small bowel stomas.
Extravasation of ingested contrast into the peritoneal cavity is visible, in favor of contrast leakage proximal to the first stoma.
The red arrows point to the arterial bypass graft. The blue arrows depict extravasated oral contrast. The yellow arrow shows the site of bowel injury and leakage. The black arrow points to the small intestine loop, which shows gut signature while the extravasated contrast at the same level and the left of the leakage site had an amorphous appearance without any wall.
Case Discussion
The diagnosis of Takayasu had been made previously in other centers, and with the steroid therapy, significant improvement in patient symptoms had occurred, but again after few months, she comes to our center with acute abdominal pain. We did not access patients' lab data or histopathological results. In young women, Takayasu arteritis should be considered in the differential diagnosis of vascular stenosis and occlusion.
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