A case of isolated SMA dissection with failed initial conservative management

Area of Science:

• Vascular Surgery
• Gastroenterology
• Radiology

Background:

• Isolated superior mesenteric dissection (ISMAD) is an uncommon vascular condition.
• It is often incidentally diagnosed in patients presenting with acute abdominal pain.
• Complications like bowel ischemia and vessel rupture necessitate early identification and treatment.

Observation:

• A 60-year-old male presented with acute abdominal pain and was diagnosed with ISMAD via CT imaging.
• Initial conservative management led to worsening pain, hypertensive crisis, and hemoperitoneum.
• Mesenteric angiography revealed a superior mesenteric artery (SMA) pseudoaneurysm.

Findings:

• The SMA pseudoaneurysm was successfully treated with coil embolization.
• The case underscores the lack of established treatment guidelines for ISMAD.
• Current evidence on nonoperative therapy effectiveness is limited by the absence of long-term relapse rate data.

Implications:

• Further research is required to establish clear management guidelines for ISMAD.
• The optimal timing for intervention (early vs. delayed) remains to be determined.
• Long-term studies are needed to assess recurrence rates and compare treatment modalities.