Difficulty of differential diagnosis of Crohn’s disease and chronic abdominal ischemia: Case report

This article presents a clinical case of chronic abdominal ischemic syndrome caused by occlusion of both the superior and inferior mesenteric arteries, combined with infrarenal aortic occlusion and iliac artery involvement, secondary to atherosclerosis of the visceral aortic branches and lower extremity arteries. Chronic abdominal ischemic syndrome is a pathological process characterized by chronic hypoperfusion of abdominal organs due to hemodynamically significant stenosis or occlusion of the visceral branches of the abdominal aorta. This syndrome is a rare cause of abdominal pain, but it is associated with high mortality and often presents a diagnostic problem for physicians. A distinctive feature of this condition is its nonspecific clinical presentation, which may mimic various gastrointestinal disorders, as demonstrated in this case report. Consequently, to reduce the number of diagnostic errors and provide timely therapy, vascular imaging modalities, such as computed tomography (CT) angiography, should be incorporated into the diagnostic algorithm for elderly patients presenting with chronic abdominal pain and weight loss, particularly those with atherosclerotic risk factors. CT angiography revealed occlusion of the infrarenal aorta, occlusion of the superior mesenteric artery and inferior mesenteric artery, and stenosis of the celiac trunk up to 30%. A unique aspect of this case was the simultaneous surgical reconstruction involving superior mesenteric artery bypass and aortobifemoral grafting via a single operative approach, highlighting advanced capabilities in modern vascular surgery.