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Updated: Jul 2, 2025
Multimodality Diagnosis of Mesenteric Ischemia
Published on: July 21, 2023
A Case of Isolated Superior Mesenteric Artery Dissection Resulting in Recurrent Necrosis of the Small Intestine
Tomohiro Takahashi1, Kengo Nishimura2, Shoichi Urushibara3
1Division of Gastrointestinal and Pediatric Surgery, Department of Surgery, School of Medicine, Faculty of Medicine, Tottori University, Yonago 683-8503, Japan.
Abstract:
Isolated superior mesenteric artery dissection (ISMAD) is a rare cause of acute abdominal conditions. Most cases of ISMAD have a favorable prognosis, and only a few cases of ISMAD-associated intestinal necrosis have been reported. A 75-year-old male was referred to our department because of abdominal pain and portal venous gas detected on imaging. Computed tomography suggested ileal necrosis, necessitating emergency surgery. Indocyanine green was used for blood flow assessment; however, no fluorescence was observed in the ileum proximal to the Bauhin valve, leading to the decision for ileocecal resection. On postoperative day 6, abdominal pain recurred when meals were resumed. As a surgical intervention for ISMAD, a bypass was created using the left great saphenous vein as a graft between the superior mesenteric artery and the right external iliac artery. This case highlights a rare occurrence where intestinal necrosis recurred due to ISMAD. We propose that in cases of ISMAD with concomitant intestinal necrosis, a more aggressive revascularization strategy for the dissected segment of the superior mesenteric artery may be required.
Insights
Isolated superior mesenteric artery dissection (ISMAD) rarely causes intestinal necrosis. This case shows recurrence of necrosis after surgery, suggesting a need for more aggressive revascularization in such rare instances.
Area of Science:
- Vascular Surgery
- Gastroenterology
- Abdominal Imaging
Background:
- Isolated superior mesenteric artery dissection (ISMAD) is a rare condition.
- Intestinal necrosis is an infrequent complication of ISMAD.
Observation:
- A 75-year-old male presented with abdominal pain and portal venous gas.
- CT scan indicated ileal necrosis, leading to emergency surgery and ileocecal resection.
- Postoperative abdominal pain recurred upon resuming meals.
Findings:
- Recurrent intestinal necrosis due to ISMAD was observed.
- A bypass graft using the left great saphenous vein was created between the superior mesenteric artery and the right external iliac artery.
- Indocyanine green angiography confirmed lack of perfusion in the proximal ileum prior to resection.
Implications:
- This case underscores the possibility of recurrent intestinal necrosis in ISMAD.
- A more aggressive revascularization strategy for the dissected superior mesenteric artery segment may be necessary for ISMAD with intestinal necrosis.
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