Chronic ischemia produces corresponding tissue hypoplasia. However, the present paper reports a distinctive hypertrophy of the intestine due to chronic mesenteric artery insufficiency. Two patients with chronic mesentery artery insufficiency confirmed by angiography are presented. The first patient demonstrated marked hypertrophy of the intestine, while the second patient was remarkable for pronounced hypoplasia. During the surgery of the first patient, an ileum approximately 60 cm long with a sausage-like consistency and cyanosis was identified proximal to the cecum; wall-attached thromboembolism material and the hypertrophic segment of ileum were removed. In the other patient, the intestine wall was paper thin; after the aortomesen-teric bypass, the intestine wall grew thicker. Postoperative recovery of both patients was uneventful. The commonly observed situation after a longstanding hypoxic insult in a setting of chronic mesenteric ischemia is that the target tissue will, at least, develop slight hypoplasia. However, the cases presented here had either pronounced hyperplasia or severe hypoplasia. The authors find this observation so interesting that they report it in the hope that an explanation for this conundrum may come forth. ? 2008 Pulsus Group Inc. All rights reserved.