Spontaneous isolated superior mesenteric artery dissection: a case report and literature review with management algorithm.
BACKGROUND
An isolated spontaneous superior mesenteric artery (SMA) dissection is the most frequent type of digestive artery dissection. Hepatic, splenic, left gastric, and celiac artery dissections are much less frequently observed. Dissection of the SMA is usually an extension of an aortic dissection. A true isolated SMA dissection is a relatively rare clinical cause of abdominal pathology. Only 106 cases (including the present case) of isolated spontaneous SMA dissection without associated aortic dissection were identified from the literature.


METHODS
Our vascular team managed a 56-year-old woman with spontaneous SMA dissection conservatively. Prior to the initiation of systemic anticoagulation, she underwent diagnostic laparoscopy. A repeat angiogram done at 2 months showed complete resolution of the dissection. She has been repeatedly examined for 5 years, which is the longest follow-up mentioned in the literature.


CONCLUSIONS
To our knowledge, this is the first case wherein laparoscopy was used to confirm the absence of mesenteric ischemia in acute presentation of SMA dissection. Using information from a review of the literature, we have designed a management protocol for this rare condition.
Subhas
Gokulakkrishna
G
Department of Surgery, Providence Hospital and Medical Centers, Southfield, MI 48075, USA. drsgokul@yahoo.com
Gupta
Aditya
A
Nawalany
Michal
M
Oppat
William F
WF
D000328:Adult; D000368:Aged; D000465:Algorithms; D000784:Aortic Dissection / Q000150:complications / Q000175:diagnosis / Q000188:drug therapy*; D000925:Anticoagulants / Q000627:therapeutic use*; D001027:Aortography / Q000379:methods; D002985:Clinical Protocols; D005260:Female; D006801:Humans; D010535:Laparoscopy; D008297:Male; D017538:Mesenteric Artery, Superior / Q000000981:diagnostic imaging; D008875:Middle Aged; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome
D000925:Anticoagulants