Panagoulias George, Tentolouris Nicholas, Ladas Spiros S
1st Department of Propaedeutic Medicine, Athens University Medical School, Laiko General Hospital, Athens, Greece.
Cases J. 2008 Sep 17;1(1):154. doi: 10.1186/1757-1626-1-154.
Chronic abdominal pain (CAP) may be a manifestation of diseases involving many intra-abdominal organs. Beside diseases affecting subjects without diabetes mellitus, diabetic patients may have CAP due to diabetes-related complications like neuritis, motor diseases of the gastrointestinal tract and autonomic dysfunction. Atherosclerosis is 2-4 times more common in patients with diabetes and affects mainly carotid, coronary, iliac and lower limb arteries as well as aorta. Another less common complication is chronic mesenteric ischemia (CMI, intestinal angina), caused by atherosclerotic obstruction of the celiac artery and its branches and results in episodic or constant intestinal hypoperfusion.
We present a case of a diabetic patient with CMI in whom the diagnosis was delayed by almost 5 years. The dominant symptoms were crampy abdominal postprandial pain, anorexia, changes in bowel habits and cachexia. Conventional angiography revealed significant stenosis of the celiac artery and complete obstruction of the inferior mesenteric artery. Noteworthy, no significant stenoses in carotids or limbs' arteries were found. Revascularization resulted in clinical improvement 1 week post-intervention.
CAP in patients with diabetes may be due to CMI. The typical presentation is crampy postprandial abdominal pain in a heavy smoker male patient with long-standing diabetes, accompanied by anorexia, changes in bowel habits and mild to moderate weight loss. At least two of the three main splanchnic arteries must be significantly occluded in order CMI to be symptomatic. The diagnostic procedure of choice is conventional angiography and revascularization of the occluded arteries is the radical treatment.
慢性腹痛（CAP）可能是涉及许多腹内器官疾病的一种表现。除了影响非糖尿病患者的疾病外，糖尿病患者可能因糖尿病相关并发症如神经炎、胃肠道运动疾病和自主神经功能障碍而出现慢性腹痛。动脉粥样硬化在糖尿病患者中更为常见，是正常人的2至4倍，主要影响颈动脉、冠状动脉、髂动脉和下肢动脉以及主动脉。另一种较不常见的并发症是慢性肠系膜缺血（CMI，肠绞痛），由腹腔动脉及其分支的动脉粥样硬化阻塞引起，导致间歇性或持续性肠道灌注不足。
我们报告一例慢性肠系膜缺血的糖尿病患者，其诊断延迟了近5年。主要症状为餐后腹部绞痛、厌食、排便习惯改变和恶病质。传统血管造影显示腹腔动脉明显狭窄，肠系膜下动脉完全阻塞。值得注意的是，在颈动脉或四肢动脉中未发现明显狭窄。血运重建术后1周临床症状改善。
糖尿病患者的慢性腹痛可能是由于慢性肠系膜缺血。典型表现为长期患有糖尿病的男性重度吸烟者餐后腹部绞痛，伴有厌食、排便习惯改变和轻度至中度体重减轻。为使慢性肠系膜缺血出现症状，三条主要内脏动脉中至少两条必须有明显阻塞。首选的诊断方法是传统血管造影，对阻塞动脉进行血运重建是根治性治疗。
