A 42-year-old Tunisian man was presented to the emergency department with acute epigastric pain, nausea and vomiting. He was a smoker and had a past medical history of hypertension. On physical examination, there was no evidence of peritonitis and vital signs were normal.Laboratory data revealed leukocytosis with a white blood cell count of 11,000/ml. There was no evident pathology in the abdominal sonographic examination. An abdominal computed tomography scan with intravenous contrast showed a normal thoraco-abdominal aorta. However, dissection of both the celiac trunk and SMA was determined. SMA dissection was classified as Sakamoto type II b. There was no bowel oedema or free fluid. The dissection of the celiac artery was approximately 22mm long with aneurysmal dilatation [
ABSTRACTIsolated arterial dissection without aortic pathology has been rarely reported in mesenteric vessels. The natural history and appropriate treatment for this disease is uncertain because of the scarcity of literature which limits the data available to the clinician, resulting in management challenges. Herein, we report a rare case of a 42-year-old Tunisian man with spontaneous dissection and aneurysmal dilatation of the Celiac Artery (CA) and the Superior Mesenteric Artery (SMA) with partial thrombosis. This case was successfully managed conservatively with heparin infusion and blood pressure control and the patient remained symptom free at 15 months follow up. This case demonstrates that conservative management may be warranted in non-complicated isolated visceral arterial dissection.the method of choice. It was based on anticoagulation, pain and hypertension control. His abdominal pain resolved in 2 days. The patient was discharged home with warfarin and aspirin. Follow-up CT scan at 3 and 6 months demonstrated that the dissections and aneurysmal dilatation were both stable. The patient was continuing to do well on his 15 month clinical follow-up. Further follow-up CT examinations were planned.
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