A Case of Isolated Dissection of the Superior Mesenteric Artery Complicating Small Intestinal Ischemia

Tsunekazu Mizushima, Mitsugu Owari, Kinya Sando, Toshikazu Ito, Hitoshi Mizuno, Shoki Mikata, Kentarou Nonaka, Satoshi Kainuma, Hiroaki Yamanaka and Kazuhiro Iwase

Department of Surgery, Rinku General Medical Center, Izumisano Municipal Hospital

Isolated dissection of the superior mesenteric artery (SMA) not associated with aortic dissection is rare. We report a case of isolated SMA dissection and review the literature. A 66-year-old man referred for acute abdominal pain had a history of appendectomy for appendicitis. Abdominal X-ray showed air-fluid levels in the right side of the abdomen. Conservative treatment for small bowel obstruction was started. The patient's symptoms worsened during the first 24 hours following conservative treatment and signs suggested peritonitis. Contrast-enhanced CT showed isolated dissection of the proximal SMA. Massive ascites and thickening of the ileal wall were also found, necessitating emergency surgery for suspected intestinal ischemia. Ileocecal resection was done for 130 cm of necrotic changes in the terminal ileum. The SMA trunk was not dilated and blood flow in other main SMA branches was maintained. We, thus, did not attempt to dissect the SMA. Three years and four months later, contrast-enhanced CT showed persistent blood flow in both the true and false lumen, but no dilation of the trunk of the SMA. The patient remains free from symptoms of intestinal ischemia.

Key words
isolated dissection, superior mesenteric artery, acute intestinal ischemia

Reprint requests
Tsunekazu Mizushima Department of Surgery, Rinku General Medical Center, Izumisano Municipal Hospital
2-23 Rinku Ohrai Kita, Izumisano, 598-0048 JAPAN

Accepted
September 22, 2004

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