Four Cases of Isolated Spontaneous Dissectin of the Superior Mesenteric Artery

Kaori Shigemitsu, Takefumi Niguma*, Yasuki Nitta* and Tetsushige Mimura*

Department of Emergency Medicine and Department of Surgery*, Okayama Saiseikai General Hospital

We report four cases of isolated spontaneous dissectin of the superior mesenteric artery (SMA) in four persons seen for abdominal pain and diagnosed using abdominal computed tomography (CT). Case 3 and 4 levealed aneurysmal formation. Case 1: A 62-year-old man diagnosed with suspected intestinal ischemia. We performed emergency surgery, thrombectomy and venous patch repair. Poor postoperative SMA blood flow necessitated emergency reoperation and broad bowel resection, but he died of disseminated intravascular coagulation (DIC) and hepatic and renal failure. Case 2-4: Men aged 51, 50, and 65 years with partial thrombosis of the false lumen were treated conservatively with vasodilators and antiplatelet and anticoagulant agents, and recovered well. Peripheral blood flow was maintained without intestinal ischemia. The 65 year-old man later developed ileus of colon transversum, and stenosis due to diteriorating blood flow of the middle colic artery requiring surgery. Isolated spontaneous dissection of the SMA requires emergency surgery for bowel necrosis and rupture, but otherwise is best met with conservative treatment and comprehensive follow-up. These, in turn, require careful evaluation of surgical indications and procedures.

Key words
superior mesenteric artery, dissection, surgical indication

Reprint requests
Kaori Shigemitsu Department of Emergency Medicine, Okayama Saiseikai General Hospital
1-17-18 Ihuku-cho, Kita-ku, Okayama, 700-8511 JAPAN

Accepted
December 16, 2009

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