Severe Abdominal Pain Eight Years after Renal Transplant: A Case of Renal Transplant Atherosclerosis

INTRODUCTION Chronic mesenteric ischemia (CMI), also known as intestinal ischemia, is a condition that occurs when plaque builds up in the major arteries that supply the small intestine.1,2 When discussing CMI, it is important to distinguish between acute and chronic mesenteric ischemia. Acute mesenteric ischemia is a medical emergency caused by an acute loss of blood flow to the small intestine, leading to bowel infarction. This is either secondary to arterial emboli, likely originating from the heart, or soft plaque rupture leading to arterial thrombosis.3 In contrast, CMI is a constant hypoperfusion of the small intestine due to significant atherosclerosis and vessel narrowing, without plaque rupture.4 CMI presents with weight loss, pain with eating, and food aversion often resulting in significant morbidity and a delayed diagnosis.4,5 The common risk factors that increase the likelihood of chronic mesenteric ischemia include age greater than 60 years, smoking history, uncontrolled dyslipidemia, diabetes, and hypertension.1,4 This is a case of an elderly female who was diagnosed with a 90% stenosis of the superior mesenteric artery (SMA), despite having few wellknown risk factors.