Isolated dissection of the superior mesenteric artery treated using open emergency surgery

Abstract

BackgroundIsolated dissection of the superior mesenteric artery (IDSMA) remains a rare diagnosis. However, new diagnostic means such as computed tomography makes it possible to detect even asymptomatic patients. If patients present symptomatic on admission, the risk of bowel infarction makes immediate therapy necessary. Today, endovascular techniques are often successfully used; however, open surgery remains important for special indications. In this paper, we present two cases with IDSMA and show why open surgical repair is still important in current treatment concepts.MethodsTwo cases with ISDMA that presented in our department from January 1, 2014 to June 1, 2014 are described. Data collection was performed retrospectively. Additionally, a review of articles which reported small cases series on patients with IDSMA within the past five years is provided.ResultsBoth patients underwent open surgical repair following interdisciplinary consultation. Both patients were transferred to the intensive care unit after surgical repair and needed bowel rest, nasogastric suction and intravenous fluid therapy. CT scans were performed within the first week after operation. Platelet aggregation inhibitors were used in both cases as postoperative medication. Both patients survived and are able to participate in everyday activities.ConclusionOpen surgical repair remains important in cases of anatomic variants of visceral arteries and suspected bowel infarction. Therefore, it is important that knowledge about open surgical techniques still be taught and trained.

Isolated Superior Mesenteric Artery Dissection with Small Intestine Ischemia

“…Contrast-enhanced CT findings are reported to be more useful than those obtained with plain CT to evaluate an existing lesion, intestinal wall thickness, and ascites [ 5 ], as plain CT results can mislead to a diagnosis of SMA dissection [ 4 ]. Reported characteristic CT findings of SMA dissection include thrombosis of a false lumen, an intimal flap, an enlarged SMA diameter, increased attenuation of fat around the SMA, and hematoma in the mesentery with hemorrhagic ascites [ 6 , 7 ]. However, it should be noted that not all cases necessarily have an intimal flap, and some show only an enlarged SMA diameter and increased attenuation of the fat around the SMA [ 8 ].…”

Chronic Mesenteric Ischemia: Patient Outcomes Using Open Surgical Revascularization

“…In this period, 224 patients (117 CMI, 55 acute mesenteric ischemia, 29 median arcuate ligament syndrome, and 23 visceral artery aneurysms) were treated for visceral artery pathologies [12][13][14][15] . For this study, we identified 100 patients and 160 arteries with a relevant stenosis or occlusion of the TC or the SMA.…”

The Classification and Management Strategy of Spontaneous Isolated Superior Mesenteric Artery Dissection

“…Although several treatment options, including conservative, endovascular, and surgical treatment, are available, there is currently no consensus regarding the optimal management of SISMAD. 1) 6) 13 14 15 16) …”