Abstract
BACKGROUND: Chronic mesenteric ischemia (CMI) is a rare but serious cause of postprandial abdominal pain and weight loss, often diagnosed late. CASE SUMMARY: We report two cases with prolonged history of vague abdominal pain, early satiety, and significant weight loss. Extensive workups for functional and structural gastrointestinal disorders were unrevealing. The diagnosis was ultimately prompted by gastroenterologist re-review of prior computed tomography abdomen studies-performed earlier during the investigation but not specifically targeting the mesenteric vasculature. On close inspection, both scans revealed extensive vascular calcifications involving the superior mesenteric and celiac arteries, which had not been mentioned in the original radiology reports. Subsequent dedicated vascular imaging confirmed significant mesenteric artery stenosis. Both patients underwent successful endovascular intervention with complete resolution of symptoms. CONCLUSION: These cases highlight the importance of clinician-led image review and maintaining a high index of suspicion for CMI in elderly patients with unexplained gastrointestinal symptoms presenting to the gastroenterology department.