Acute Mesenteric Ischemia Associated with Chronic Aortoiliac Occlusion: An Unusual Presentation of Leriche Syndrome

Background: Leriche syndrome is a form of chronic aortoiliac occlusive disease resulting from obstruction of the distal abdominal aorta and iliac arteries. Chronic arterial occlusion allows the development of extensive collateral pathways that may maintain distal perfusion. In advanced disease, involvement or dysfunction of the mesenteric arterial circulation may result in mesenteric ischemia. Case presentation: We report the case of a 60-year-old man presenting with acute abdominal pain. Contrast-enhanced computed tomography angiography demonstrated complete occlusion of the infrarenal abdominal aorta, extending to both common iliac arteries, associated with occlusion of the inferior mesenteric artery. The celiac trunk, superior mesenteric artery [SMA], and both renal arteries remained patent and showed adequate contrast opacification. In contrast, the inferior mesenteric artery [IMA] was not opacified, consistent with associated mesenteric arterial occlusion. The bowel showed circumferential mural thickening, submucosal edema, and mesenteric hyperemia, without significant mesenteric fat stranding or peritoneal effusion, findings suggestive of early intestinal hypoperfusion rather than established transmural ischemic injury. Extensive arterial collateralization was observed. Conclusion: Early intestinal hypoperfusion may occur in the setting of chronic aortoiliac occlusive disease and represents a diagnostic and therapeutic challenge. Computed tomography angiography is essential for simultaneously assessing the aortoiliac occlusion, mesenteric arterial circulation, collateral pathways, and early bowel-wall changes. Recognition of these findings, together with the absence or presence of signs of irreversible bowel injury, is crucial for appropriate management.