Table 1.

Data summary of patients with TAO and gastrointestinal tract involvement

No	Year	Authors	The number of patients	Age	Chief complaint	Duration of disease (amputation)	Smoking status	How to diagnose the current disease	Suggested treatment	The outcome of treatment
1	2016	Enshaei et al (Iran)3	1	39 years	Acute abdominal pain	Below-knee (BK) amputation 5 years earlier	1.5 packs of cigarette for 25 years	Previous diagnosis of TAO Abdominal X-ray laboratory tests Angiographic and histhopathological examinations	Resection the gangrenous part of ileum (25 cm) following ileostomy	Two more laparotomy after the initial one because of the bilious discharge.
2	2016	Bouomrani et al (Tunisia)4	1	42 years	Recurrent duodenal ulcer lasting for 5 years which did not improve by the well- anti-ulcer treatment	Disease diagnosis 15 years earlier and two toe amputations during this time	Two packs of cigarettes for more than 15 years	Previous diagnosis of TAO according to clinical features, angiography and laboratory tests Endoscopy and histological examination of the ulcer	Anti-ulcer treatment in addition to anticoagulant and vasodilation treatment	Ulcer healing after two months confirmed by endoscopy No ulcer recurrence after four years follow-up
3	2016	Shastri et al (India)5	1	53 years	Diffuse abdominal pain with distention and constipation for 5 days following episodes of bloody stool, and bilious vomiting due to segmental ileum ischemia	Calf claudication 2 months earlier and gangrene of right 2nd and 5th toes 10 days earlier	One pack of cigarette for 20 years	TAO diagnosis according to clinical examination and laboratory tests Histological examination of ileum	Resection of 167 cm of ileum following anticoagulant treatment.	Recovery
4	2014	Kamiya et al (Japan)6	1	48 years (woman)	Acute severe and persisted abdominal pain	TAO diagnosis three years earlier She underwent below-knee amputation 3 years earlier and the diagnosis of TAO was confirmed by histological examination	Smoking one pack of cigarette daily before the disease diagnosis	Acute mesenteric artery occlusion in addition to multiple small infarctions in the kidneys was observed in the abdominal computed tomography Spleen infarction 1 day after the laparotomy The histological examination was not typical for TAO but more likely emboli. The source for emboli was thoracic aorta. However, the underlying cause of thrombus formation inside thoracic aorta remained elusive according to laboratory tests and intensive heart examination.	Resection of entire small intestine and the right side of the colon. Anti-coagulation therapy	Transient liver dysfunction after the surgery.
5	2010	Lee et al (Korea)7	2	Case 1: 65 years Case 2: 39 years	Case 1: Periumbilical and right lower quadrant pain with bloody diarrhea for 2 months. Pain worsening following constipation and abdominal distention in the last 3 days Case 2: Right lower quadrant pain and bloody stool for 5 days. Intermittent abdominal pain several months earlier.	Case 1: TAO diagnosis 16 years earlier and right BK amputation 11 years before colon ischemia Case 2: TAO diagnosis 5 years earlier according to clinical manifestation and angiography. He underwent toe amputation during this time	Case 1: smoking one pack of cigarette for 20 years but stopped smoking 3 years before colon ischemia. Case 2: one pack of cigarettes for 16 years	Case 1: Abdominal computed tomography Histological examination Case 2: Abdominal computed tomography Mesenteric angiography	Case 1: Rectosigmoid resection Case 2: Conservative treatment	Case 1- Recovery Case 2- Recovery
6	2009	Çakmak et al (Turkey)8	1	48 years	Postprandial abdominal pain and 25 kg weight loss within a year.	TAO diagnosis 14 years earlier and toe amputations during this time (Angiography confirmation)	Two packs of cigarette for 25 years	CT angiography of celiac trunk and superior and inferior mesenteric arteries Histophatological confirmation after hemicolcetomy and ileum resection	First approach was angioplasty and stenting After 2 years, right hemicolectomy and partial ileum resection because of revascularization failure	Recovery
7	2009	Turkbey et al (Turkey)9	1	35 years	Increase in abdominal pain that was ongoing for 4 months	TAO diagnosis 20 years earlier and history of two BK amputation	Unknown	Abdominal CT angiography	Resection 200 cm of jejunum	Recovery
8	2006	Leung et al (NewYork, USA)10	1	34 years	Abdominal pain, nausea and vomiting with weight loss about 10 kg over 6 months.	TAO diagnosis according to clinical manifestation and angiography several weeks before mesenteric ischemia The patient was under treatment with anticoagulants and calcium channel blocker	Lengthy history of smoking	According to Magnetic resonance imaging and abdominal CT scan Small splenic and renal infarction was also observed Histological examination of small intestine and superior mesenteric artery confirmed the diagnosis of TAO	Resection of the of almost all of the small and large bowels	Discharged from hospital with hospice care at home.
9	2005	Cho et al (Korea)11	1	37 years	2-day history of diffuse abdominal pain and a 2-month history of claudication of his left hand	TAO diagnosis according to angiography and histological examination of small bowel	One pack of cigarette for 20 years	Abdominal CT scan Histological examination of small intestine confirmed the diagnosis of TAO	Resection of small bowel (40 cm)	Recovery
10	2003	Kobayashi et al (Japan)12	1	42 years	Abdominal pain with muscle guarding	TAO diagnosis according to Shionoya’s criteria and excluding other types of vasculitis 8 months earlier and he had one BK amputation during this time. He was under treatment of warfarin and ticlopidine.	Two packs of cigarettes for 20 years	Angiography According to autopsy and histological examination including posterior tibialis artery the diagnosis of TAO was confirmed	The ileum end, cecum and proximal side of the ascending colon and sigmoid colon were necrotic and resected	Death
11	2003	Cho et al (Korea)13	1	38 years	Obstipation and diffuse abdominal pain with 5 days duration	TAO diagnosis according to clinical manifestation and histological confirmation of minor amputation 14 years earlier The patient also underwent BK amputation during this time	One pack of cigarette for 18 days	Physical examination and emergency laparotomy Histology confirmed TAO diagnosis	Resection of 100 cm of small bowel	Unknown
12	2003	Kurata et al (Japan)14	1	35 years	Sudden onset of abdominal pain	TAO diagnosis 10 months earlier and lumbar sympathectomy during this time (Angiography chractristics for TAO)	One pack of cigarette for 15 years	Abdominal X-Ray and emergency laparotomy Histology confirmed TAO diagnosis	Resection of small bowel including ileocecal (54 cm)	Recovery
13	2001	Sidiqqui et al (NewYork, USA)15	1	51 years	7-month history of abdominal pain and under corticosteroid treatment by the diagnosis of Crohn’s disease Acute abdominal pain in the hospital due to non-healing ulcer of ingrown toenail	TAO diagnosis at the onset of acute abdomen by lower limb angiography The diagnosis was confirmed by histological exam after autopsy	Smoking for 26 years	Abdominal CT scan -Aortogram -Angiography Histology confirmed TAO diagnosis	Plasmapheresis and high-dose steroids temporary improvement but small bowel resection (36 cm) 2 months later	Death due to recurrent intestinal ischemic perforations, and sepsis
14	2001	Hassoun et al (Belgium)16	1	50 years	3-month history of postprandial epigastric pain, vomiting, and diarrhea and weight loss around 15 kg over the past 5 months	TAO diagnosis 30 years earlier and one BK and several minor amputations during this time	One pack of cigarette for 32 years	Abdominal CT scan Angiography	Conservative treatment	Recovery
15	1998	Iwai (Japan)17	3	Case 1: 51 years Case 2: 43 years Case 3: 43 years (identical twin of case 2)	Case 1: Epigastric pain Case 2: Postprandial abdominal pain for 2 years following 15 kg weight loss in one year Case 3: abdominal angina	Case 1: TAO diagnosis according to clinical manifestation and angiography 10 years earlier Case 2: TAO diagnosis according at the time of abdominal pain according to clinical manifestation and lower limb angiography Case 3: TAO diagnosis at the time of abdominal angina according to clinical manifestation of lower limbs and angiography and aortography	Case 1: one pack of cigarettes for 30 years Case 2: unknown Case 3: unknown	Case 1: Upper GI series showed deformity of the duodenal bulbus and ulcer formation. Histology of right gastric artery was compatible with diagnosis of TAO Case 2: Aortography Case 3: Aortography Histology of splenic artery was compatible with TAO diagnosis	Case 1: Gastrectomy Case 2: bypass revascularization and sympathectomy of mesentric and celiac ganglia Case 3: Bypass surgery	Case 1- Recovery Case 2- Failure of vascular reconstruction two years after bypass surgery Case 3- Recovery
16	1998	Michail et al (Greece)18	1	42 years	History of chronic abdominal pain Reported with acute abdominal pain and vomiting	TAO diagnosis according to clinical manifestation and angiography at the time of hospital admission	Heavy smoker for 24 years	Abdominal X-rays Angiography Histology confirmed TAO diagnosis	Partial enterectomy	Recovery
17	1998	Lie (California, USA)19	4	Range from 35 to 41 years	Unknown	Duration of the disease is unknown but all the cases had at least one leg amputations	Unknown	Unknown But Ileum, ascending colon, jejunum and sigmoid colon were infarcted or gangrenous in the four cases	Resection of ileum and ascending colon in two cases Other two cases died before surgical intervention	50% Death
18	1996	Sauvaget et al (France)20	1	36 years	Dysentery associated with a weight loss of 12 kg following acute abdomen	TAO diagnosis at the workup for the cause of dysentery Angiography of the lower limbs were characteristics for TAO	17 pack-year	Colonoscopy which showed diffuse superficial ulcerations, with a deep ulceration of the sigmoid colon. Unresponsive to amebicides Histology exam confirmed TAO diagnosis	Resection of sigmoid 17 cm Intravenous heparin and prostacyclin	Recovery
19	1995	Burke et al (Washington, USA)21	2	Case 1: 39 years Case 2: 48 years	Unknown	Unknown	Heavy smokers	Unknown Histology exam confirmed TAO diagnosis	Unknown	Case 1-Recovery Case 2-recurrecnt strictures at bowel anastomosis during 4 years follow-up
20	1994	Schellong et al (Germany)22	1	23 years	9-month history of postprandial abdominal pain and weight loss about 15 kg Referred from another hospital by diagnosis of mesenteric ischemia confirmed by angiography	TAO diagnosis at the workup for the acute abdominal pain	20–30 cigarettes for 5 years	Abdominal examination Angiography Raising liver enzymes -Histologic examination was compatible with TAO	Thrombectomy and short vein bypass from the aorta to the common hepatic artery	Recovery
21	1994	Saboya et al (Brasil)23	1	34 years	Because of 8 hrs intestine pain in the lower abdomen and obstipation	Two BK amputations 2 years earlier	Unknown but give up smoking for 2 years	Laparotomy due to abdominal examination and laboratory tests Histology was supportive for TAO	Resection of sigmoid colon (28 cm was necrotic) and rectum	Discharged with colostomy
22	1993	Ito et al (Japan)24	1	42 years	Acute right lower quadrant pain and with severe tenderness and slight muscle guarding previous history of abdominal colicky pain and vomiting	TAO diagnosis 14 years earlier and two BK amputations during this time and several toe amputations	30 cigarettes daily for 20 years	Laparotomy by primary diagnosis of diverticulitis (The patient had appendectomy before) Postoperative aortography and histology of cecum and small mesenteric vessels confirmed TAO diagnosis	Ileocecal resection	Recovery
23	1993	Broide et al (Israeal)25	1	20 years	Severe abdominal pain and vomiting of 3 days duration	TAO diagnosis 2 years after acute abdomen according to clinical manifestations, laboratory investigation and angiography	Two to three packs of cigarette for 5 years	Retrograde diagnosis of TAO for mesenteric ischemia	Resection of jejunum Histology demonstrated well-organized thrombi in branches of superior mesenteric artery	Recovery
24	1983	Soo et al (Australia)26	1	48 years	Abdominal pain in right iliac fossa with rebound and tenderness	TAO diagnosis 7 years earlier according to clinical manifestation The patient underwent one BK amputation and several toe amputations Histology examination confirmed the diagnosis of TAO	Three packs of cigarette a day	The pre-operative diagnosis was appendicitis During the surgery 8 cm infarcted sigmoid colon was observed. Histology study confirmed the diagnosis of TAO in the colon. Appendix was macroscopic and microscopic normal.	Resection of sigmoid colon	Recovery
25	1979	Borlaza et al (Michigan, USA)27	1	36 years	2-week history of abdominal pain with nausea and vomiting and weight loss	TAO diagnosis after abdominal pain according to clinical manifestation, angiography of lower limbs	Two packs of cigarettes per day for 21 years	Laparotomy by initial diagnosis of intussusception and resection if ileum Histology findings was suggestive for BD Aortography was also supportive for visceral TAO	Resection of ileum (30 cm)	Recovery
26	1979	Sobel et al (California, USA)28	1	35 years	During hospital admission for non-healing wound of amputation stump, the patient developed abdominal pain following decreased consciousness and generalized seizure	TAO diagnosis 10 years earlier and one BK amputation Histology had confirmed TAO	One to two packs of cigarette for 25 years	In autopsy necrotic pancreas and infarcted spleen due to occlusion of celiac and splenic artery and hemorrhagic bilateral adrenal necrosis and hemorrhagic infarction of pituitary and cerebral cortices Histology of celiac artery was supportive for TAO diagnosis	Nothing for the abdominal pain due to acute renal failure	Death
27	1977	Sachs et al (Texas, USA)29	1	45 years	Constant left upper quadrant abdominal pain History of 1 year anorexia and weight loss	TAO diagnosis at the time of admission for abdominal pain	Two packs of cigarettes for 30 years	Barium enema and aortography Histology was supportive for TAO diagnosis	Resection of transverse colon	Unknown
28	1972	Wolf et al (Washington, USA)30	2	Case 1: 53 Case 2: 43	Case 1: Obstipation and persistent abdominal pain with vomiting Case 2: Reporting with gastrointestinal hemorrhage and shock Nausea and cramping abdominal pain 5 days before admission.	Case 1: BD diagnosis 18 years earlier and one BK amputation during this time Case 2: BD diagnosis 2 years earlier and one BK amputation Histology confirmed the diagnosis of TAO	Case 1: 30 cigarettes per day for 38 years Case 2: 20 to 40 cigarettes per day for 30 years	Case 1: Abdominal examination and exploring laparotomy which showed two small abdominal wall abscesses Since the abscesses could not explain the pain of the patient, biopsy from jejunal mesenteric arcade was obtained The histological findings were supportive for visceral BD Case 2: At autopsy, thrombosis of portal vein, which extended into the superior mesenteric vein and the infarction of jejunum histology demonstrated neutrophilic infiltration of vein wall	Case 1: Unknown Case 2: Intravenous infusion of saline	Case 1: Unknown Case 2: Death
29	1968	Herrington et al (Tennessee, USA)31	2	Case 1: 33 years Case 2: 42 years	Case 1: Several days of cramping, left lower quadrant abdominal pain following severe tenderness Case 2: 8 months cramping abdominal pain, anorexia, and weight loss of 20 pounds following severe abdominal pain	Case 1: TAO diagnosis at the onset of acute abdomen according to past medical history and clinical manifestation and histology exam of the sigmoid colon Case 2: TAO diagnosis at the onset of acute abdomen. Angiography of upper and lower limbs confirmed the diagnosis of TAO	Case 1: Smoking for years Case 2: Smoking 60 cigarettes per day for 24 years	Case 1: Laparotomy by the suspicious of sigmoid diverticulitis Histology confirmed TAO diagnosis Case 2: laparotomy by the primary diagnosis of appendicitis. However, appendices was normal but jejunum was ischemic.	Case 1: Resection of sigmoid colon Case 2 Resection of jejunum (60 cm)	Case 1: Recovery Case 2: Recovery after resection of jejunum but 1 month later he had massive melena and then death
30	1966	Rob et al (New York, USA)32	1	46 years	Cramping and spasmodic, central abdominal pain associated with diarrhea and weight loss	TAO diagnosis many years earlier and two BK amputations during this time	Unknown	Abdominal X-ray Aortography was normal however the histological exam of the resected bowel confirmed the diagnosis of TAO in the thrombotic occluded vessels in the mesentery	Resection the ischemic part of small bowel	Unknown
31	1953	Kilbourne et al (Chicago, USA)33	1	35 years	Epigastric pain, vomiting and blood loss in stool	TAO diagnosis 1 year earlier and one BK amputation	Heavy smokers	Laparotomy by primary diagnosis of superimposed polyps or Carcinoma. During the surgery stomach was found to be 3 to 4 times normal thickness and somewhat spongy from cardia to antrum, where there was an abrupt change to normal consistency and thickness. perigastric nodes were enlarged up to 4 by 2 cm Histology demonstrated no malignancy but perivascular inflammation without thrombotic occlusion.	The involved portion of the stomach was resected	Recovery
32	1947	Garvin (Pennsylvania, USA)34	1	33 years	Abdominal pain, distention and vomiting History of same presentation 8 years earlier	TAO diagnosis 8 months earlier	Unknown	Laparotomy by diagnosis of mesenteric ischemia The histology was supportive for TAO diagnosis	Resection 45 cm of gangrenous proximal ilium	Unknown