Isolated superior mesenteric artery dissection

Abstract

Isolated superior mesenteric artery (SMA) dissection without involvement of the aorta and the SMA origin is unusual. We present a case of an elderly gentleman who had chronic abdominal pain, worse after meals. CT angiography, performed on a 64-slice CT scanner, revealed SMA dissection with a thrombus. A large artery of Drummond was also seen. The patient was managed conservatively.

A rare cause of acute abdomen: spontaneous dissection of the superior mesenteric artery

“…The etiology of spontaneous SMA dissection has not yet been established, but has been associated with atherosclerosis, cystic medial necrosis, fibromuscular dysplasia, connective tissue disorders, trauma, elastic tissue disorders (Marfan and Ehlers–Danlos syndrome), abnormal curvature of the origin of the SMA, and uncontrolled hypertension . It has been hypothesized by Solis et al that the dissection usually begins 1.5–3 cm from the orifice of the SMA, thus sparing the origin of the artery .…”

“…It has been hypothesized by Solis et al that the dissection usually begins 1.5–3 cm from the orifice of the SMA, thus sparing the origin of the artery . This hypothesis is based on the fact that this segment of the artery is exposed to high shearing forces because of its anatomical location . It exits the pancreas at its border between the fixed retropancreatic portion and the more distal mobile mesenteric portion .…”

“…This hypothesis is based on the fact that this segment of the artery is exposed to high shearing forces because of its anatomical location . It exits the pancreas at its border between the fixed retropancreatic portion and the more distal mobile mesenteric portion . On the microscopic level, there is fragmentation of the elastic fibers, loss of and dispersement of smooth muscle cells, degradation of the internal elastic lamina, areas of cystic degeneration, and atheromatous changes in the arterial wall .…”

“…The pain is caused by inflammation around the dissecting SMA and intestinal ischemia. The pain may be initiated or exacerbated after meals when there is an increased oxygen demand by the intestines . Other common symptoms are nausea, vomiting, diarrhea, melena, and abdominal distension .…”

Isolated dissection of the superior mesenteric artery: a case report and literature review

“…[7][8][9][10][11][12][13] Angiography is currently the gold standard imaging technique for diagnosing SMA dissection. 16 Recently, contrast-enhanced computed tomography (CT) has become the most reliable diagnostic modality; indeed, diagnosis in the acute stage has become possible as a result of advanced and increasing use of CT imaging techniques, 17 such as MDCT, leading to multiplanar reconstruction and reconstruction imaging, 18 and computed tomography angiography (CTA). [19][20][21][22][23] MDCT usually shows that the diameter of the SMA is enlarged and that there is increased attenuation of the fat surrounding the artery itself, together with images of true and false lumina, which can be identified by the presence of an intimal flap after the origin of the SMA (Table 2).…”