Resistant hypertension and mesenteric ischemia: A unique therapeutic journey

Chronic mesenteric ischemia (CMI) typically presents with postprandial pain, food aversion, and weight loss. This case report describes an atypical presentation of CMI with intolerance to anti-hypertensive drugs. A 54-year-old woman presented with uncontrolled hypertension, bilateral renal artery stenosis, and intolerance to antihypertensive medications. Angiography revealed occlusion of all three mesenteric arteries, compensated by collateral circulation from internal the iliac arteries. Elevated blood pressure was crucial for maintaining intestinal blood flow via collaterals. A right iliac to IMA bypass successfully improved intestinal perfusion, resolving medication intolerance and successfully lowering the patient's blood pressure. This case highlights an exceptional presentation of occlusive mesenteric disease and underscores the importance of individualized approaches in complex mesenteric ischemia cases.