{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,24]],"date-time":"2026-07-24T05:02:12Z","timestamp":1784869332457,"version":"3.55.0"},"reference-count":21,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2026,7,24]],"date-time":"2026-07-24T00:00:00Z","timestamp":1784851200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Med."],"abstract":"<jats:p>Gastrointestinal involvement is common in systemic sclerosis (SSc), but severe abdominal pain should not be attributed automatically to dysmotility or malabsorption. We report a 72-year-old woman with long-standing limited cutaneous SSc who developed recurrent severe abdominal pain, progressive oral-intake limitation, and marked weight loss. Abdominal computed tomography angiography showed high-grade calcified stenosis at the superior mesenteric artery (SMA) origin together with a reduced aortomesenteric angle of 17 degrees and a distance of 4.7\u202fmm, creating a coexisting SMAS-like anatomic context. After multidisciplinary review, endovascular balloon angioplasty and stent implantation were performed because the SMA lesion was considered a major treatable vascular contributor in a frail patient at high operative risk. Severe pain improved and oral intake advanced after revascularization, but portal-hypertensive disease, partial small-bowel obstruction, severe malnutrition, and SSc-related gastrointestinal involvement remained plausible concurrent contributors. Follow-up CTA in March 2024 showed post-stent changes without recurrent acute mesenteric ischemia, but long-term stent-patency and nutritional-recovery data were limited. This case does not establish a new causal mechanism; rather, it illustrates a structured approach to severe abdominal pain in SSc that distinguishes a treatable vascular lesion from SMAS-like anatomy and other nonvascular abdominal disease.<\/jats:p>","DOI":"10.3389\/fmed.2026.1882228","type":"journal-article","created":{"date-parts":[[2026,7,24]],"date-time":"2026-07-24T04:23:40Z","timestamp":1784867020000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":0,"title":["Case Report: Vascular abdominal pain in systemic sclerosis\u2014chronic mesenteric ischemia from high-grade superior mesenteric artery stenosis with coexisting aortomesenteric narrowing"],"prefix":"10.3389","volume":"13","author":[{"given":"Ji","family":"Li","sequence":"first","affiliation":[{"name":"Department of Rheumatology and Immunology, Peking University International Hospital","place":["Beijing, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jing","family":"Zhang","sequence":"additional","affiliation":[{"name":"Department of Rheumatology and Immunology, Peking University International Hospital","place":["Beijing, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sheng-Guang","family":"Li","sequence":"additional","affiliation":[{"name":"Department of Rheumatology and Immunology, Peking University International Hospital","place":["Beijing, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lina","family":"Zhang","sequence":"additional","affiliation":[{"name":"Department of Rheumatology and Immunology, Peking University International Hospital","place":["Beijing, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yadan","family":"Zou","sequence":"additional","affiliation":[{"name":"Department of Rheumatology and Immunology, Peking University International Hospital","place":["Beijing, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ting","family":"Long","sequence":"additional","affiliation":[{"name":"Department of Rheumatology and Immunology, Peking University International Hospital","place":["Beijing, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ruohan","family":"Yu","sequence":"additional","affiliation":[{"name":"Department of Rheumatology and Immunology, Peking University International Hospital","place":["Beijing, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yanfeng","family":"Zhang","sequence":"additional","affiliation":[{"name":"Department of Rheumatology and Immunology, Peking University International Hospital","place":["Beijing, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2026,7,24]]},"reference":[{"key":"ref1","doi-asserted-by":"publisher","first-page":"1685","DOI":"10.1016\/s0140-6736(17)30933-9","article-title":"Systemic sclerosis","volume":"390","author":"Denton","year":"2017","journal-title":"Lancet"},{"key":"ref2","doi-asserted-by":"publisher","first-page":"15002","DOI":"10.1038\/nrdp.2015.2","article-title":"Systemic sclerosis","volume":"1","author":"Allanore","year":"2015","journal-title":"Nat Rev Dis Primers"},{"key":"ref3","doi-asserted-by":"publisher","first-page":"559","DOI":"10.1097\/mcg.0000000000000334","article-title":"Gastrointestinal manifestations, malnutrition, and role of enteral and parenteral nutrition in patients with scleroderma","volume":"49","author":"Bharadwaj","year":"2015","journal-title":"J Clin Gastroenterol"},{"key":"ref4","doi-asserted-by":"publisher","first-page":"883","DOI":"10.1111\/apt.13963","article-title":"Review article: pathogenesis and clinical manifestations of gastrointestinal involvement in systemic sclerosis","volume":"45","author":"Kumar","year":"2017","journal-title":"Aliment Pharmacol Ther"},{"key":"ref5","doi-asserted-by":"publisher","first-page":"49","DOI":"10.1016\/j.bpg.2017.01.003","article-title":"Diagnosis and treatment of chronic mesenteric ischemia: an update","volume":"31","author":"Kolkman","year":"2017","journal-title":"Best Pract Res Clin Gastroenterol"},{"key":"ref6","doi-asserted-by":"publisher","first-page":"371","DOI":"10.1177\/2050640620916681","article-title":"European guidelines on chronic mesenteric ischaemia - 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