Case Report: A Patient with Dissection of the Superior Mesenteric Artery

• Published in: Nihon Fukubu Kyukyu Igakkai Zasshi (Journal of Abdominal Emergency Medicine) Vol. 25; no. 3; pp. 543 - 547
• Main Authors: Onodera, Makoto, Fujino, Yasuhisa, Saito, Kazuyoshi, Sato, Nobuhiro, Endo, Shigeatsu, Suzuki, Yasushi, Yaegashi, Yasunori, Kojika, Masahiro, Inoue, Yoshihiro
• Format: Journal Article
• Language: Japanese
• Published: Japanese Society for Abdominal Emergency Medicine 2005; 日本腹部救急医学会
• Subjects: 上腸間膜動脈解離; 急性腹症
• ISSN: 1340-2242; 1882-4781
• DOI: 10.11231/jaem1993.25.543

We report a patient with dissection of the superior mesenteric artery (SMA). A 55-year-old man reporting epigastric pain was found in abdominal ultrasonography to have shifted blood flow in the SMA. Abdominal computed tomography (CT) at branching from the renal vein showed a 4cm dissection, about 2cm away from the SMA origin. No arterial branches of the SMA distal to the dissection were visualized. Minilaparotomy offering direct visualization of the intestine showed. Decreased peristalsis in part of the ileum. Decreased blood flow in the appendicular artery was confirmed by an incision; but it was nonetheless maintained. Since the time-course of changes suggested possible intestinal ischemia, the patient was transferred to intensive care unit (ICU) without abdominal closure. The following day, gross examination confirmed the viability of the whole intestine. When, 18 hours after transfer to the ICU, no intestinal ischemia was recognized and intestinal viability was reconfirmed, the abdomen was closed. Postoperative multidetector CT and angiography showed the SMA to be completely occluded after the first two branches to the jejunum. The development of the jejunal branches and bypass led to revascularization of the area dominantly supplied by the SMA. Dissection of the SMA is rare, with only 21 patients, including our own, reported in the literature. Cases in the literature are discussed in terms of diagnosis and treatment.