Venous Congestion in Transmesenteric Hernia After Superior Mesenteric Artery Stenting for Chronic Mesenteric Ischemia

Endovascular stenting is commonly done for chronic mesenteric ischemia (CMI). We report a case of venous congestion in transmesenteric hernia following superior mesenteric artery (SMA) stenting for CMI. A 52-year-old man with a history of extended right hemicolectomy presented with post-prandial abdominal pain for two months. Computed tomography (CT) revealed celiac axis occlusion, high-grade ostial stenosis of the superior and inferior mesenteric arteries, and transmesenteric hernia with volvulus. The patient underwent SMA stenting, and his post-prandial pain resolved. Two days later, he developed right iliac fossa pain. CT revealed the dilatation of mesenteric veins, lymphadenopathy, and fat stranding within the hernia sac, and ascites, suggesting venous congestion and impending strangulation. The patient underwent laparotomy and hernia repair, following which his symptoms resolved.