A 52-year-old man presented to the emergency department with acute severe epigastric pain that had existed for 2 hours. He had no prior medical history or recent abdominal trauma. Physical examination revealed normal hemodynamic parameters and tenderness over the epigastric area without rebound tenderness. Laboratory blood tests were normal except for an elevated serum lactate (4.1 mmol/l). An abdominal ultrasound scan was without pathological findings.Abdominal computed tomographic angiography (CTA) showed an isolated dissection of the superior mesenteric artery (SMA), without ischemic changes of the bowel (Panel A). Digital subtraction angiography (DSA) confirmed the dissection (Panel B). Via transfemoral approach, two stents were placed proximally in the SMA (Panel C). Postprocedural angiography showed filling of the true lumen of the SMA with good outflow. Three hours post-intervention, serum lactate levels had normalized and pain was resolved.The post-procedural course was uneventful and the patient was discharged on the second post-procedural day with prophylactic acetylsalicylic acid. After 6 months' follow-up, repeated abdominal duplex ultrasonography showed normal flow in the SMA and the patient remained in a good clinical condition and was free of complaint.Isolated spontaneous dissection of the SMA is rare. Several reported risk factors include atherosclerosis, fibromuscular dysplasia, pregnancy, connective tissue disorders, Vascular Medicine 16(1) 79-80
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