'Intersplanchnic steal syndrome': another cause for reversible distal colon ischaemia

Ischemic disease of the colon is generally attributed to small vessel disease. Not infrequently, however, lesions of the inferior mesenteric artery are identified causing insufficiency either by thrombotic or embolic occlusion of the vessel, or by low perfusion associated with shock, massive hemorrhage, etc. Recently another cause of inferior mesenteric artery insufficiency was encountered, namely an 'intersplanchnic steal' phenomenon. Arteriographic studies demonstrated severe stenosis of the superior mesenteric artery. The flow of blood in this situation was diverted from the inferior mesenteric artery to supply the superior mesenteric vessel resulting in ischemic disease of the distal colon. This collateral pathway is a well known route of support to areas of decreased perfusion within the splanchnic bed. A search of the literature has revealed no case in which this abnormal flow pattern has resulted in ischemic disease of the normally vascularized bowel. It is believed, therefore, that this case of 'intersplanchnic steal syndrome' warrants inclusion in the radiologic literature as an unusual manifestation of reversible colonic ischemia. A case is presented.