Rare Case of “Wandering Artery of Drummond” As a Result of Chronic Triple Mesenteric Vessel Occlusion Treated by Isolated Angioplasty and Stenting of the Inferior Mesenteric Artery

Abstract

We report a rare clinical scenario of chronic mesenteric ischemia (CMI) patient with obstruction of all the three major gut vessels including celiac, superior mesenteric artery (SMA), and inferior mesenteric artery (IMA) with a sole artery supplying the collaterals through marginal artery of left colon (the “wandering artery of Drummond”). A 70-year-old man was presented to hospital with acute onset of dyspnea, diaphoresis, severe epigastric pain, nausea, and vomiting that started after lunch. Initially, patient was diagnosed and treated for non-ST elevation myocardial infarction (NSTEMI). Furthermore, work-up, including computed tomographic scan of abdomen followed by angiogram, revealed 100% obstruction of celiac and SMA, whereas inferior IMA had 90% ostial lesion with poststenotic dilatation and collaterals supplying to entire colon. Subsequently, IMA ostial lesion was stented through percutaneous intervention and patient noted significantly improved symptoms and quality of life. To conclude, percutaneous endovascular treatments confer favorable strategy for CMI, and it may either be curative or allow nutritional optimization before definitive surgery.

Keywords

non-ST elevation myocardial infarction - superior mesenteric artery - inferior mesenteric artery

• References

• 1 Shaw RS, Green Jr TH. Massive mesenteric infarction following inferior mesenteric-artery ligation in resection of the colon for carcinoma. N Engl J Med 1953; 248 (21) 890-891
• 2 Gibbons CP, Roberts DE. Endovascular treatment of chronic arterial mesenteric ischemia: a changing perspective?. Semin Vasc Surg 2010; 23 (1) 47-53
• 3 Mikkelsen WP. Intestinal angina: its surgical significance. Am J Surg 1957; 94 (2) 262-267 , discussion, 267–269
• 4 Jackson JE. Vascular anatomy of the gastrointestinal tract. In: Butler P, Mitchell AWM, Ellis H, , eds. Applied Radiological Anatomy. Cambridge: Cambridge University Press; 1999: 223-237
• 5 Loffroy R, Steinmetz E, Guiu B , et al. Role for endovascular therapy in chronic mesenteric ischemia. Can J Gastroenterol 2009; 23 (5) 365-373
• 6 Kolkman JJ, Mensink PB, van Petersen AS, Huisman AB, Geelkerken RH. Clinical approach to chronic gastrointestinal ischaemia: from 'intestinal angina' to the spectrum of chronic splanchnic disease. Scand J Gastroenterol Suppl 2004; 241 (241) 9-16
• 7 Schermerhorn ML, Giles KA, Hamdan AD, Wyers MC, Pomposelli FB. Mesenteric revascularization: management and outcomes in the United States, 1988-2006. J Vasc Surg 2009; 50 (2) 341-348 , e1
• 8 Gotsman I, Verstandig A. Intravascular stent implantation of the celiac artery in the treatment of chronic mesenteric ischemia. J Clin Gastroenterol 2001; 32 (2) 164-166
• 9 Landis MS, Rajan DK, Simons ME, Hayeems EB, Kachura JR, Sniderman KW. Percutaneous management of chronic mesenteric ischemia: outcomes after intervention. J Vasc Interv Radiol 2005; 16 (10) 1319-1325
• 10 Alam A, Uberoi R. Chronic mesenteric ischemia treated by isolated angioplasty of the inferior mesenteric artery. Cardiovasc Intervent Radiol 2005; 28 (4) 536-538
• 11 Crotch-Harvey MA, Gould DA, Green AT. Case report: percutaneous transluminal angioplasty of the inferior mesenteric artery in the treatment of chronic mesenteric ischaemia. Clin Radiol 1992; 46 (6) 408-409
• 12 Kougias P, Huynh TT, Lin PH. Clinical outcomes of mesenteric artery stenting versus surgical revascularization in chronic mesenteric ischemia. Int Angiol 2009; 28 (2) 132-137
• 13 Klepczyk L, Keeling WB, Stone PA, Shames ML. Superior mesenteric artery stent fracture producing stenosis and recurrent chronic mesenteric ischemia: case report. Vasc Endovascular Surg 2008; 42 (1) 79-81