Isolated Superior Mesenteric Artery Dissection with Small Intestine Ischemia
Related Experiment Video
Updated: Mar 29, 2026
Multimodality Diagnosis of Mesenteric Ischemia
Published on: July 21, 2023
Masahito Aimi1, Chika Amano2, Rika Yoshida3
1Second Department of Internal Medicine, Shimane University School of Medicine, Izumo-shi, Japan.
Abstract:
Superior mesenteric artery (SMA) dissection without aortic dissection is a rare condition, and its diagnosis is considered to be difficult. Intestinal infarction is a severe complication of the disease, which may require resection of the intestine. We present a case of isolated SMA dissection. A 53-year-old man experienced sudden pain in the abdomen while playing Japanese pinball and was admitted to our hospital due to acute abdominal symptoms of uncertain cause. Enhanced CT revealed a defect of the root of the SMA, while angiography and intravascular ultrasound findings showed dissection of the SMA wall. Conservative treatment was chosen at the time, while a part of the small intestine was eventually resected because of progressive ischemia. Although SMA dissection is a rare occurrence in cases with acute abdominal symptoms, awareness of the condition is important for differential diagnosis.
Insights
Isolated superior mesenteric artery (SMA) dissection is a rare cause of acute abdominal pain. Early diagnosis and awareness are crucial for managing this condition and preventing intestinal infarction.
Area of Science:
- Vascular Surgery
- Gastroenterology
- Diagnostic Imaging
Background:
- Superior mesenteric artery (SMA) dissection, without concurrent aortic dissection, is an uncommon yet critical vascular emergency.
- Prompt diagnosis is challenging due to its rarity and nonspecific acute abdominal symptoms.
Observation:
- A 53-year-old male presented with sudden, severe abdominal pain.
- Diagnostic imaging, including enhanced CT, angiography, and intravascular ultrasound, confirmed an isolated SMA dissection.
Findings:
- Initial conservative management was initiated for the SMA dissection.
- Despite treatment, progressive ischemia necessitated partial small intestine resection.
Implications:
- This case highlights the importance of considering isolated SMA dissection in the differential diagnosis of acute abdominal pain.
- Increased awareness can lead to earlier detection and potentially improved patient outcomes, reducing the need for bowel resection.
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