Jejunal Artery Reconstruction using Right Gastroepiploic Artery in a Patient with Spontaneous Superior Mesenteric Artery Dissection and Severe Postprandial Mesenteric Angina

Hideaki Uchiyama, Masazumi Kume, Hiroshi Matsuura, Atsushi Fukuda, Kenichiro Okadome and Yoshihiko Maehara*

Department of Surgery, Saiseikai Fukuoka General Hospital
Department of Surgery and Science, Graduate School of Medical Sciences, Kyushu University*

Spontaneous superior mesenteric artery (SMA) dissections are rare events. We report successful jejunal artery reconstruction using the right gastroepiploic artery in a patient with spontaneous SMA dissection and severe postprandial mesenteric angina. A 42-year-old man seen for severe postprandial abdominal pain and diagnosed with mesenteric angina due to spontaneous SMA dissection was found in computed tomography to have dissected SMA 3 cm distal from its origin, necessitating emergency surgery to avoid necrotic change in the small intestine if at all possible due to its high mortality. Laparotomy showed the small intestine to not be necrotic but had a dark color due to poor blood flow. The dissection extended into the origin of the small branches to the jejunum, ileum, ascending colon, and transverse colon, suggesting potential necrosis, if dissection progressed. Although restoration of blood flow to the small intestine was recommended, it was not possible to reconstruct all small SMA branches, so the fourth jejunal artery was reconstructed using the right gastroepiploic artery to avoid total necrosis of the small intestine. The whole intestinal blood flow was restored via the marginal artery as a result of this reconstruction. The man was treated for postoperative anticoagulation using heparin followed by warfarin. The postoperative course was uneventful and postprandial abdominal pain completely disappeared.

Key words
superior mesenteric artery, dissection, vascular reconstruction

Reprint requests
Hideaki Uchiyama Department of Surgery, Saiseikai Fukuoka General Hospital
1-3-46 Tenjin, Chuo-ku, Fukuoka, 810-0001 JAPAN

Accepted
May 21, 2008

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