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A case of isolated SMA dissection with failed initial conservative management

Year: 2024

Type: article

Abstract: Isolated superior mesenteric dissection (ISMAD) is an uncommon condition, often diagnosed incidentally for presentations of acute abdominal pain. Early identification and treatment are crucial as complications such as bowel ischemia or vessel rupture can occur. There remain no established treatment guidelines, making surgical and endovascular indications controversial. A 60-year-old male presented with acute abdominal pain, and was diagnosed with ISMAD via computed tomography imaging. He was initially managed conservatively which progressed to worsening abdominal pain, hypertensive crisis, and hemoperitoneum on follow-up computed tomography angiography (CTA). A mesenteric angiogram revealed a pseudoaneurysm in the superior mesenteric artery (SMA) which was subsequently treated with coil embolization. The absence of long-term evidence on relapse rates questions the overall effectiveness of nonoperative therapy. Further research is needed to establish clear guidelines and to determine whether early intervention might be more advantageous in managing complications and preventing recurrence.

Source: Journal of Surgical Case Reports

DOI: 10.1093/jscr/rjae789

Authors: Salma Emara, Madison Kropp, Masoud Akbari, Kristin Cook

Institutions: Rowan University, Hackensack Meridian Health

Language: English

Topic: Abdominal vascular conditions and treatments

Subfield: Surgery

Field: Medicine

Domain: Health Sciences

SDG: Good health and well-being

Open Access status: gold

Estimated APC paid: $1,050