Refractory Chronic Abdominal Pain: An Unusual Manifestationof Superior Mesenteric Artery Thrombosis

Abstract

Mesenteric ischemia is an uncommon but potentially life-threatening condition, associated with high morbidity and mortality when diagnosis is delayed. Thrombosis of the Superior Mesenteric Artery (SMA) is one of the main causes of arterial mesenteric ischemia and is typically characterized by sudden onset of severe abdominal pain. However, in selected cases, particularly when the obstruction is partial or develops progressively, the clinical presentation may be insidious, mimicking more common gastrointestinal disorders.

Chronic postprandial abdominal pain, progressive weight loss, nausea, vomiting, and intolerance to oral intake are typical features of chronic or subacute mesenteric ischemia. The coexistence of dyspeptic symptoms or upper gastrointestinal bleeding may further obscure the diagnosis and lead to delays in appropriate management. Contrast-enhanced computed tomography currently represents the diagnostic modality of choice, allowing early detection of vascular involvement before the development of irreversible intestinal ischemia.

We report a case of partial mural thrombosis of the superior mesenteric artery presenting as chronic epigastric pain and upper gastrointestinal bleeding, highlighting the diagnostic challenges and the importance of considering vascular etiologies in patients with refractory abdominal symptoms.