Acute-on-chronic mesenteric ischaemia by early and diffuse atherosclerosis in a young adult patient

Description

A 48-year-old Caucasian man with gypsy ethnicity had smoking habits (35 pack-years) and previous alcohol consumption (10 g/day; abstinent for 3 years). There was no relevant personal/family cardiovascular disease, history of illicit drug abuse, non-steroidal anti-inflammatory drug use or other previous/current medications. He had a 3-year history of chronic diarrhoea (3–4 bowel movements/day), abdominal pain and weight loss (25.9% of usual weight; body mass index=13.7 kg/m²). In the last month, an exacerbation of abdominal pain occurred with excruciating postprandial episodes requiring opioid analgesia. Laboratory analysis showed leucocytosis (34.8; N: 4–11x10⁹/L), neutrophilia (90.6%), normocytic/normochromic anaemia (haemoglobin: 8.0; N: 13–17 g/dL), high Erythrocyte sedimentation rate (ESR) (54; N<20 mm/hour), faecal calprotectin (4890; n<50 mg/kg) and C-reactive protein (CRP) (10.7; N<0.5 mg/dL). Oesophagogastroduodenoscopy and ileocolonoscopy with biopsies showed multiple Helicobacter pylori-negative gastroduodenal ulcers (figure 1A,B) and non-specific mild ulceration of the terminal ileum and proximal colon, without granulomas. CT enterography showed distended small bowel loops without...

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