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      Isolated Superior Mesenteric Artery Dissection: A Case Report and Literature Review

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          Abstract

          Spontaneous isolated superior mesenteric artery dissection (ISMAD) is an uncommon cause of abdominal pain. Clinical presentation ranges from an asymptomatic incidental finding to acute bowel ischemia or fatal aneurysmal super mesenteric artery (SMA) rupture. We report the case of a 58-year-old male presenting with abdominal pain. Imaging studies revealed an ISMAD without radiological evidence of bowel ischemia. The patient was successfully treated using a conservative approach including bowel rest and anticoagulation. ISMAD incidence is expected to increase with the utilization of advanced imaging modalities. Thus, an ISMAD should be suspected when other common causes of an acute abdomen have been excluded. Given the lack of evidence-based guidelines, management options include conservative treatment and anticoagulation, endovascular stenting, or open surgical repair.

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          Clinical and angiographic follow-up of spontaneous isolated superior mesenteric artery dissection.

          Theresa Kim, Kwang Kim, Susan W Yun … (2009)
          To observe the clinical features and angiographic findings in patients with a spontaneous isolated superior mesenteric artery dissection (SISMAD) and to identify any correlation between them. From a single institution, 32 patients (22 symptomatic patients at presentation; mean age 54years; men 97%) with SISMAD were retrospectively reviewed. All patients were available for clinical follow-up after treatment (conservative, n=28, 88%, open or endovascular superior mesenteric artery (SMA) reconstruction, n=4, 12%), and follow-up CT scans were available in 28 patients (mean 22months, range 1-80months). We found a positive correlation between pain severity and dissection length (p=0.03, rho=0.50, Spearman's partial correlation analysis). After conservative treatment, only one patient (3%) required bowel resection, and there was no difference in outcome between patients who were treated with anticoagulation or anti-platelet therapy and those who were not (p=1.00, Fisher's exact test). No patients had progression of their lesion on the follow-up CT angiography. In SISMAD patients, dissection length is positively associated with more severe clinical symptoms. After conservative treatment, we observed a benign clinical course and no CT progression of the dissection, even without anticoagulation or anti-platelet therapy. Based on our observation, patients with SISMAD can be treated conservatively without anticoagulation therapy.
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            Imaging appearances and management of isolated spontaneous dissection of the superior mesenteric artery.

            Ichiro Sakamoto, Yoji Ogawa, Eijun Sueyoshi … (2007)
            The objective of our study was to report the clinical and imaging features of isolated dissection of the superior mesenteric artery (SMA) and describe our imaging classification of this disease entity. We retrospectively analyzed clinical presentation, imaging appearances and outcome of the 12 patients who were diagnosed as having spontaneous dissection of the SMA from 1991 to 2005 in our institution or its affiliated two hospitals. There were 11 males and 1 female with a mean age of 50 years (range, 43-61 years). The diagnosis of isolated dissection was established with CT within 24h of the onset. We categorized SMA dissection into the following four types based on imaging appearances: type I, patent false lumen with both entry and re-entry (four patients), type II, 'cul-de-sac' shaped false lumen without re-entry (one patient), type III, thrombosed false lumen with ulcer like projection (ULP), which is defined as a localized blood-filled pouch protruding from the true lumen into the thrombosed false lumen (five patients) and type IV, completely thrombosed false lumen without ULP (two patients). One patient with type II underwent urgent surgery because of small bowel ischemia. One patient with type III underwent urgent embolotherapy for the treatment of rupture of a branch of the SMA. The remaining 10 patients were initially managed conservatively. In one of the conservatively treated patient, ULP had progressively dilated, and it was treated with stent placement and coil packing 22 months after the onset. The remaining nine patients were conservatively managed without any event during the follow-up period of 7-72 months. Most of the patients with isolated SMA dissection can initially be managed conservatively if there are no clinical and imaging signs indicating ruptured SMA branches or bowel ischemia.
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              Dissecting aneurysm of the aorta; a presentation of 15 cases and a review of the recent literature.

              S R BAUERSFELD (1947)
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                Author and article information

                Journal
                Journal ID (nlm-ta): Gastroenterology Res
                Journal ID (iso-abbrev): Gastroenterology Res
                Journal ID (publisher-id): Elmer Press
                Title: Gastroenterology Research
                Publisher: Elmer Press
                ISSN (Print): 1918-2805
                ISSN (Electronic): 1918-2813
                Publication date (Print): October 2018
                Publication date (Electronic): 1 October 2018
                Volume: 11
                Issue: 5
                Pages: 374-378
                Affiliations
                [a ]Department of Internal Medicine, Advocate Illinois Masonic Medical Center, 836 W Wellington Ave., Chicago, IL 60657, USA
                [b ]Department of Internal Medicine, Detroit Medical Center/Wayne State University School of Medicine, Detroit, MI, USA
                Author notes
                [c ]Corresponding Author: Hussein Daoud, Department of Internal Medicine, Advocate Illinois Masonic Medical Center, 836 W Wellington Ave., Chicago, IL 60657, USA. Email: hussein.daoud@ 123456advocatehealth.com
                Article
                DOI: 10.14740/gr1056w
                PMC ID: 6188040
                PubMed ID: 30344810
                SO-VID: 74a7b5ec-be59-4595-b196-b8171aa01ff1
                Copyright © Copyright 2018, Daoud et al.
                License:

                This article is distributed under the terms of the Creative Commons Attribution Non-Commercial 4.0 International License, which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

                History
                Date received : 18 June 2018
                Date accepted : 8 August 2018
                Categories
                Subject: Case Report

                Keywords: superior mesenteric artery dissection,hypertension
                Data availability:
                Keywords: superior mesenteric artery dissection, hypertension

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