Spontaneous dissection of the superior mesenteric artery (SMA) is rare and has been reported only sporadically. Therapeutic options are either a surgical approach, which is the more frequently adopted, or a simple observation. We report a case of spontaneous dissection of the SMA with a review of the literature and present a new therapeutic approach.

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Middle mesenteric artery has been described in 1923. We report the observation of a patient with an abdominal aortic aneurysm who had this rare artery arising from the anterior wall of the aneurysmal sac. His inferior mesenteric artery was occluded at its origin from the aorta and the middle and the distal colon was vascularized only by the middle mesenteric artery. Occlusion of this artery would have been necessary before endovascular repair of the aneurysm. We were concerned about the risk of colic ischemia after the occlusion of the middle mesenteric artery, so we abandoned this approach and operated on the patient via a laparotomy. Based on a case report, we here report a literature overview on the repair of abdominal aortic aneurysm in the presence of a middle mesenteric artery.

Several CT scan scores have been proposed to discriminate between splenic injuries requiring surgical intervention, and those that may be treated conservatively. The aim of this study is to compare three selected CT scan scores (Buntain, Mirvis, Resciniti) in their ability to correctly define the proper course of therapy following splenic injury. 44 adult patients presenting an isolated splenic trauma, confirmed by CT scan on admission and treated solely according to clinical criteria, have been studied. The 44 CT scans were retrospectively classified according to the three CT scan scoring systems. Correlation with the treatment performed allows the specificity and sensitivity of each score to be calculated and compared. The best score (Resciniti) uses a combination of parenchymal and intra-abdominal liquid scores. The use of such a scoring system alone to dictate therapy would have resulted in either an increased rate of surgical intervention, or an unacceptable rate of failure of conservative treatment. However, the determination of the expected rate of failure of conservative treatment can be useful in determining the level and frequency of serial surveillance examinations.