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Chirurgia 2017 August;30(4):142-6

DOI: 10.23736/S0394-9508.16.04619-2

Copyright © 2016 EDIZIONI MINERVA MEDICA

lingua: Inglese

Two cases of spontaneous isolated dissection of the superior mesenteric artery treated with conservative therapy

Hiroyuki SAISHO , Teiji OKAZAKI, Koichiro SHIMOISHI, Hidetsugu HORI, Keiichiro TAYAMA

Department of Cardiovascular Surgery, Cardiovascular Center, Munakata Suikokai General Hospital, Fukuoka, Japan


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Spontaneous isolated dissection of the superior mesenteric artery (SIDSMA) is a rare vascular disease. The risk factors, causes, and natural history of SIDSMA are unclear due to its rarity but hypertension and smoking are considered to be risk factors and no standard treatment has been established. The main symptom of the SMA dissection is acute abdominal pain due to the dissection itself, bowel ischemia, or intraperitoneal hemorrhage secondary to arterial rupture. However, some cases experience only vague abdominal discomfort. Therefore, the diagnosis of the SMA dissection is difficult and requires a high index of clinical suspicion and the use of imaging modalities such as CT, CT angiography, catheter angiography and MRI. We experienced two cases of SIDSMA presenting with acute abdominal pain. Neither case showed any evidence of bowel infarction and computed tomography (CT) showed no aneurysmal dilatation. Therefore, they were treated with conservative therapy and no surgical or endovascular intervention was performed. Abdominal pain resolved quickly and follow-up CT demonstrated no extension of the dissection and no aneurysmal dilatation in either patient. Both patients have remained symptom-free after discharge. There is no consensus on the optimal management of SIDSMA, but nonopeartive treatment with close observation is thought to be an acceptable strategy. Herein, we report two patients of SIDSMA who were managed successfully with a nonoperative approach and describe the management strategy.


KEY WORDS: Mesenteric artery, superior - Dissection - Therapeutics - Tomography, X-Ray computed

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Publication History

Issue published online: June 27, 2017
Manuscript accepted: October 3, 2016
Manuscript received: June 13, 2016

Per citare questo articolo

Saisho H, Okazaki T, Shimoishi K, Hori H, Tayama K. Two cases of spontaneous isolated dissection of the superior mesenteric artery treated with conservative therapy. Chirurgia 2017;30:142-6. DOI: 10.23736/S0394-9508.16.04619-2

Corresponding author e-mail

saisho_hiroyuki@med.kurume-u.ac.jp