Isolated Superior Mesenteric Artery Dissection After Cesarean Delivery: A Case Report

Isolated superior mesenteric artery dissection (ISMAD) is an uncommon vascular disorder that may present with acute abdominal pain and is most frequently reported in middle-aged men with cardiovascular risk factors. Its occurrence during the postpartum period is extremely rare, and diagnosis after cesarean delivery can be challenging because abdominal pain, anemia, abdominal distension, and hemoperitoneum may initially be attributed to postoperative bleeding or other obstetric and surgical complications. We report the case of a 43-year-old woman, gravida 2 para 1, who developed sudden upper abdominal pain on postoperative day 4 after an uncomplicated cesarean delivery. She had no relevant medical or family history. On presentation, her blood pressure was 168/71 mmHg, and physical examination revealed mild abdominal distension and epigastric tenderness without peritoneal signs. Computed tomography (CT) revealed pelvic hemoperitoneum, and contrast-enhanced CT demonstrated an intimal flap in the superior mesenteric artery, consistent with ISMAD. There was no contrast extravasation, the distal superior mesenteric artery branches were patent, and no radiologic findings suggested bowel ischemia. Because active arterial bleeding, intestinal ischemia, and arterial rupture were absent, conservative management with strict blood pressure control, close observation, serial clinical assessment, and blood transfusion was selected. Her symptoms improved, and she was discharged without complications. Follow-up contrast-enhanced CT at 12 months showed that the dissection had become less conspicuous, and she remained recurrence-free. This case highlights that ISMAD should be considered in postpartum women with atypical, severe, persistent, or disproportionate abdominal pain, even when postoperative bleeding appears to be a plausible explanation. Early contrast-enhanced CT is essential for distinguishing postoperative hemorrhage from visceral arterial dissection, evaluating bowel ischemia, and guiding appropriate management. To our knowledge, this is the first reported case of ISMAD after cesarean delivery.