{"id":11090,"date":"2026-06-11T11:52:07","date_gmt":"2026-06-11T11:52:07","guid":{"rendered":"https:\/\/www.kauveryhospital.com\/ima-journal\/?p=11090"},"modified":"2026-06-12T06:13:28","modified_gmt":"2026-06-12T06:13:28","slug":"a-silent-vessel-a-catastrophic-gut-acute-mesenteric-ischemia-in-takayasu-arteritis","status":"publish","type":"post","link":"https:\/\/www.kauveryhospital.com\/ima-journal\/ima-journal-june-2026\/a-silent-vessel-a-catastrophic-gut-acute-mesenteric-ischemia-in-takayasu-arteritis\/","title":{"rendered":"A Silent Vessel, A Catastrophic Gut: Acute Mesenteric Ischemia in Takayasu Arteritis"},"content":{"rendered":"

[vc_section][vc_row][vc_column][vc_column_text]<\/p>\n

Introduction<\/h2>\n

Acute mesenteric ischemia (AMI) is a life-threatening vascular emergency caused by abrupt compromise of intestinal perfusion, often associated with high morbidity and mortality. Early diagnosis is crucial to prevent irreversible bowel infarction. Contrast-enhanced CT angiography (CTA) is the imaging modality of choice for rapid and comprehensive evaluation of mesenteric vasculature and bowel viability.<\/p>\n

While embolic and thrombotic occlusions of the superior mesenteric artery (SMA) are the most common causes of AMI, vasculitides such as Takayasu arteritis rarely involve mesenteric vessels. Inflammatory arterial involvement may predispose to luminal narrowing and thrombosis, leading to bowel ischemia.<\/p>\n

We present a case of acute mesenteric ischemia in a patient with known aorto-arteritis, demonstrating inflammatory involvement of the superior mesenteric artery with distal branch thrombosis and advanced ischemic bowel changes on CT angiography.<\/p>\n

Case Presentation<\/h2>\n

A patient with known aorto-arteritis presented with persistent upper abdominal pain associated with nausea. There was no history of vomiting, fever, or diarrhoea.<\/p>\n

On examination, epigastric and periumbilical tenderness with guarding and sluggish bowel sounds were noted. Given the suspicion of vascular pathology, multidetector CT angiography was performed.<\/p>\n

Imaging Findings<\/h2>\n

Vascular Findings<\/h2>\n

The proximal and mid segments of the superior mesenteric artery demonstrated irregular eccentric wall thickening with surrounding inflammatory soft tissue, causing mild luminal narrowing (<50%), consistent with active arteritis.<\/p>\n

Complete thrombosis was noted in the left-sided jejunal and ileal branches of the SMA. Partial thrombosis was also seen in the right-sided ileocolic branches, associated with perivascular inflammatory changes.<\/p>\n

Other major abdominal vessels, including the celiac axis and inferior mesenteric artery, were unremarkable.<\/p>\n

\"\"<\/figure>\n

Bowel Findings<\/strong><\/p>\n

Multiple jejunal and proximal ileal loops were markedly distended and demonstrated:<\/p>\n