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Case Reports
. 2018 Oct 31;2018(10):rjy274.
doi: 10.1093/jscr/rjy274. eCollection 2018 Oct.

Non-operative management of isolated spontaneous superior mesenteric artery dissection

Lauryn A Ullrich  1 , William Streiff  1 , David R Mariner  2 , Boyoung Song  2 , Melissa A Obmann  2 , Shivprasad D Nikam  2
Affiliations
Case Reports

Non-operative management of isolated spontaneous superior mesenteric artery dissection

Lauryn A Ullrich et al. J Surg Case Rep. .

Abstract

Isolated spontaneous superior mesenteric artery (SMA) dissection is a rare differential for patients presenting with abdominal pain. Due to limited cases reported, management strategies have been poorly defined. We present the case of a 49-year-old male with history of hypertension and ischemic colitis, presenting with abdominal pain. CT imaging demonstrated a thrombosed dissection of the SMA extending into second and third order braches. He was managed conservatively with therapeutic anticoagulation. His symptoms improved and upon discharge he was transitioned to aspirin and warfarin. Repeat CT imaging continued to show the dissection with resolution of the SMA thrombus. Spontaneous SMA dissection is exceedingly rare with no universally agreed upon standard of care for treatment. Operative intervention should be reserved for failed conservative management or vascular compromise. Understanding the current treatment options helps ensure a favorable patient outcome.

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Figures

Figure 1:
Figure 1:
Initial imaging showing a thrombosed dissection, originating 2 cm from the ostium of the SMA with extension into the second and third order branches.
Figure 2:
Figure 2:
Selective jejunal thrombosis on repeat imaging.
See this image and copyright information in PMC

References

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