Ischaemic Strictures of the Jejunum

Abstract

Background: The most common causes of mechanical small bowel obstruction are postoperative adhesions and hernias. Commoner sites in the small bowel are the ileum and ileocaecal junction and jejunum is a rare site for obstruction and strictures. Other etiologies of small bowel obstruction include, diseases intrinsic to the wall of the small intestine, benign (like, inflammatory, ischaemic post-traumatic or post irradiation) or malignant strictures. Intramural hematoma and processes that cause intraluminal obstruction like intussusception, gallstones, foreign bodies etc also contribute. Ischaemic enteritis is a rare etiology, with only about 0.1 percent of cases being reported. Ischaemic strictures of the small bowel are a result of decreased blood supply to the small intestine. They necessitate surgical intervention to be managed.

Study Objectives: The main objectives were to study the importance of details of clinical and investigative modalities in diagnosis and management of ischaemic jejunal strictures which are rare causes of intestinal obstruction like in the case described.

Methods: The author presented a 40-year-old diabetic female with a 2-month history of upper GI obstruction. Her health records included a stroke, a myocardial infarction, and a transient episode of intestinal obstruction three years ago. Her investigations revealed that she had an occlusive distal jejunal stricture. The author researched various management options in the literature and chose the best one for her.

Results: An exploratory laparotomy was performed, along with resection and end-to-end anastomosis of the jejunal segment. The segment's histopathology revealed ischaemic enteritis with large vessel blockade causing stricture. The patient's postoperative recovery was uneventful, and she has been asymptomatic for two years now. 

Conclusions: Ischaemic enteritis results in small intestinal obstruction due to intestinal stricture in its chronic phase. The differential diagnoses cause diagnostic delay, as can missing the transient phase of early ischemia which gives a lead to diagnosis.