Abstract
Chronic mesenteric ischemia is an infrequent but potentially debilitating condition that can result in irreversible intestinal injury when diagnosis or treatment is delayed. Although revascularization can restore mesenteric blood flow and improve symptoms, structural bowel damage acquired during prolonged hypoperfusion may persist or manifest later. Chronic ischemic strictures of the small intestine are rare and diagnostically challenging, particularly when involving the terminal ileum, where they may mimic inflammatory, infectious, or neoplastic disorders. We report the case of a 55-year-old woman with multiple cardiovascular risk factors who presented with progressive postprandial abdominal pain, weight loss, and early satiety. Initial imaging revealed high-grade stenosis of the superior mesenteric artery, which was confirmed on angiography and successfully treated with endovascular stent placement. Despite partial symptomatic improvement, the patient re-presented weeks later with acute right lower quadrant abdominal pain. Repeat imaging demonstrated segmental narrowing and inflammatory changes of the terminal ileum, while the mesenteric stent remained patent. Further evaluation with a barium follow-through study confirmed a fixed, short-segment ileal stricture consistent with chronic disease. After exclusion of alternative etiologies, a diagnosis of chronic ischemic stricture of the terminal ileum was established, likely related to longstanding mesenteric hypoperfusion before revascularization. The patient was managed conservatively with clinical improvement and remains under close follow-up. This case emphasizes that restoration of mesenteric arterial flow does not necessarily prevent delayed ischemic complications of the bowel. Persistent or new gastrointestinal symptoms following revascularization should prompt evaluation for chronic ischemic strictures, particularly in patients with significant vascular risk factors, to avoid misdiagnosis and delays in appropriate management.