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Management of spontaneous isolated dissection of the superior mesenteric artery: Case report and literature review.

Katsura M, Mototake H, Takara H, Matsushima K - World J Emerg Surg (2011)

Bottom Line: The SMA was repaired by bypass graft in two cases, and in one of these, the graft was occluded because of prominent native flow from the SMA.All patients were symptom free and there was no evidence of disease recurrence after a median follow-up of 4.3 years.Although the indications for surgery are still controversial, we should proceed with exploratory laparotomy if the patient has acute symptoms with suspicion of mesenteric ischemia.

View Article: PubMed Central - HTML - PubMed

Affiliation: Department of General Surgery, Okinawa Prefectural Hokubu Hospital, 2-12-3 Onaka, Nago, Okinawa 905-8512, Japan. morihiro@bj8.so-net.ne.jp.

ABSTRACT

Background and method: The aim of this study was to assess retrospectively the clinical presentation, management and outcome of three patients with isolated SMA dissection encountered at Okinawa Prefectural Chubu Hospital, Japan from 2005 to 2006, along with a review of the literature. We follow up the patient's clinical symptoms and the image by using enhanced dynamic CT at 1 week, 1 or 2 months, 6 months, and yearly after onset.

Case presentation: We present three patients with acute abdominal pain due to spontaneous dissection of the superior mesenteric artery (SMA), who were treated by surgical revascularization or conservative management. Two patients underwent surgery because of signs or symptoms of intestinal ischemia and one patient elected conservative management. The SMA was repaired by bypass graft in two cases, and in one of these, the graft was occluded because of prominent native flow from the SMA. All patients were symptom free and there was no evidence of disease recurrence after a median follow-up of 4.3 years.

Conclusion: Although the indications for surgery are still controversial, we should proceed with exploratory laparotomy if the patient has acute symptoms with suspicion of mesenteric ischemia. A non-operative approach for SMA dissection requires close follow-up abdominal CT, with a focus on the clinical signs of mesenteric ischemia and the vascular supply of the SMA, including collateral flow from the celiac artery and inferior mesenteric artery.

No MeSH data available.


Related in: MedlinePlus

Sakamoto's type III dissection of the SMA. (a) preoperative three-dimensionally reconstructed images showing severe stenosis of the SMA with ULP, and the collateral flow from the celiac artery and inferior mesenteric artery. (b) postoperative 1 year abdominal enhanced CT scan show a thrombosed false lumen completely resolved without progressive dilation of ULP.
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Figure 3: Sakamoto's type III dissection of the SMA. (a) preoperative three-dimensionally reconstructed images showing severe stenosis of the SMA with ULP, and the collateral flow from the celiac artery and inferior mesenteric artery. (b) postoperative 1 year abdominal enhanced CT scan show a thrombosed false lumen completely resolved without progressive dilation of ULP.

Mentions: A 47-year-old man with a 5-day history of acute epigastric pain with radiation to the back was admitted. No associated symptoms of fever, nausea, constipation or diarrhea were present. He was previously healthy and had no cardiovascular risk factors and recent trauma. On physical examination, mild tenderness over the epigastrium without signs of peritonitis sign was observed, and no bruit was audible. Laboratory tests and abdominal radiography were unremarkable. Contrast-enhanced CT revealed a thin flap of the SMA, which began from just after the orifice of the SMA and separated the SMA into two distinct lumina; the resulting false lumen was thrombosed in the mid to distal portion of the SMA. Three-dimensionally reconstructed images demonstrated severe stenosis of the SMA, but no sign of bowel ischemia caused by prominent collateral flow from the celiac artery and inferior mesenteric artery (figure 3a). We chose conservative treatment without anticoagulation therapy. The abdominal pain completely disappeared on day 2 and he was discharged on day 4. The patient was symptom free 4 years after discharge with no recurrent symptoms and disease progression. One year after surgery, a thrombosed false lumen completely resolved with ULP on follow up CT (figure 3b).


Management of spontaneous isolated dissection of the superior mesenteric artery: Case report and literature review.

Katsura M, Mototake H, Takara H, Matsushima K - World J Emerg Surg (2011)

Sakamoto's type III dissection of the SMA. (a) preoperative three-dimensionally reconstructed images showing severe stenosis of the SMA with ULP, and the collateral flow from the celiac artery and inferior mesenteric artery. (b) postoperative 1 year abdominal enhanced CT scan show a thrombosed false lumen completely resolved without progressive dilation of ULP.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC3108290&req=5

Figure 3: Sakamoto's type III dissection of the SMA. (a) preoperative three-dimensionally reconstructed images showing severe stenosis of the SMA with ULP, and the collateral flow from the celiac artery and inferior mesenteric artery. (b) postoperative 1 year abdominal enhanced CT scan show a thrombosed false lumen completely resolved without progressive dilation of ULP.
Mentions: A 47-year-old man with a 5-day history of acute epigastric pain with radiation to the back was admitted. No associated symptoms of fever, nausea, constipation or diarrhea were present. He was previously healthy and had no cardiovascular risk factors and recent trauma. On physical examination, mild tenderness over the epigastrium without signs of peritonitis sign was observed, and no bruit was audible. Laboratory tests and abdominal radiography were unremarkable. Contrast-enhanced CT revealed a thin flap of the SMA, which began from just after the orifice of the SMA and separated the SMA into two distinct lumina; the resulting false lumen was thrombosed in the mid to distal portion of the SMA. Three-dimensionally reconstructed images demonstrated severe stenosis of the SMA, but no sign of bowel ischemia caused by prominent collateral flow from the celiac artery and inferior mesenteric artery (figure 3a). We chose conservative treatment without anticoagulation therapy. The abdominal pain completely disappeared on day 2 and he was discharged on day 4. The patient was symptom free 4 years after discharge with no recurrent symptoms and disease progression. One year after surgery, a thrombosed false lumen completely resolved with ULP on follow up CT (figure 3b).

Bottom Line: The SMA was repaired by bypass graft in two cases, and in one of these, the graft was occluded because of prominent native flow from the SMA.All patients were symptom free and there was no evidence of disease recurrence after a median follow-up of 4.3 years.Although the indications for surgery are still controversial, we should proceed with exploratory laparotomy if the patient has acute symptoms with suspicion of mesenteric ischemia.

View Article: PubMed Central - HTML - PubMed

Affiliation: Department of General Surgery, Okinawa Prefectural Hokubu Hospital, 2-12-3 Onaka, Nago, Okinawa 905-8512, Japan. morihiro@bj8.so-net.ne.jp.

ABSTRACT

Background and method: The aim of this study was to assess retrospectively the clinical presentation, management and outcome of three patients with isolated SMA dissection encountered at Okinawa Prefectural Chubu Hospital, Japan from 2005 to 2006, along with a review of the literature. We follow up the patient's clinical symptoms and the image by using enhanced dynamic CT at 1 week, 1 or 2 months, 6 months, and yearly after onset.

Case presentation: We present three patients with acute abdominal pain due to spontaneous dissection of the superior mesenteric artery (SMA), who were treated by surgical revascularization or conservative management. Two patients underwent surgery because of signs or symptoms of intestinal ischemia and one patient elected conservative management. The SMA was repaired by bypass graft in two cases, and in one of these, the graft was occluded because of prominent native flow from the SMA. All patients were symptom free and there was no evidence of disease recurrence after a median follow-up of 4.3 years.

Conclusion: Although the indications for surgery are still controversial, we should proceed with exploratory laparotomy if the patient has acute symptoms with suspicion of mesenteric ischemia. A non-operative approach for SMA dissection requires close follow-up abdominal CT, with a focus on the clinical signs of mesenteric ischemia and the vascular supply of the SMA, including collateral flow from the celiac artery and inferior mesenteric artery.

No MeSH data available.


Related in: MedlinePlus