Isolated superior mesenteric artery dissection in a patient without risk factors or aortic dissection

Spontaneous Superior Mesenteric Artery (SMA) Dissection: An Unusual Cause of Abdominal Pain

“…Because it is so rare, no official sensitivity studies regarding imaging techniques for this condition are available. Doppler sonography can be used to detect the arterial lesion, and recently, Chang et al described SMA dissection identified by abdominal ultrasound (6,11). Abdominal plain films may reveal ileus, but are generally non-specific (2,4).…”

“…Another, less common presentation is one of Spontaneous SMA Dissection 577 chronic intestinal angina, including postprandial pain, anorexia, and vomiting (2). Patients are often tender to palpation in the epigastrium or left upper quadrant; rarely, an audible epigastric bruit may be appreciated (6). More dramatic presentations are also possible, and include hemorrhagic shock due to arterial rupture (1,2).…”

“…The other presentation is one of chronic intestinal angina, including postprandial pain, anorexia, and vomiting (2). Patients are usually tender to palpation in the epigastrium or left upper quadrant; rarely, an audible epigastric bruit may be appreciated (6). Computed tomography (CT) scan of the abdomen with intravenous (i.v.)…”

Isolated dissection of the superior mesenteric artery: a case report and literature review

“…7,8 The most frequently reported risk factors include hypertension, atherosclerosis, fibromuscular dysplasia, cystic medial necrosis, and abdominal aortic aneurysm (Table 1); however, some dissections appear to occur spontaneously, without any identifiable etiology. 9 Solis et al hypothesized that dissection usually begins 1.5-3 cm from the orifice of the SMA, thus sparing the origin of the artery. This segment of SMA corresponds with the exit of the artery from the pancreas, exactly where it is exposed to shearing forces, because this area represents the border zone between the fixed retropancreatic portion and the more mobile distal mesenteric one.…”

“…Abdominal echocolor Doppler can be useful for demonstrating and following up hemodynamic changes within the SMA, bowel movements, and signs of bowel ischemia, such as wall thickening and dilated intestinal loops. [7][8][9][10][11][12][13] Angiography is currently the gold standard imaging technique for diagnosing SMA dissection. 16 Recently, contrast-enhanced computed tomography (CT) has become the most reliable diagnostic modality; indeed, diagnosis in the acute stage has become possible as a result of advanced and increasing use of CT imaging techniques, 17 such as MDCT, leading to multiplanar reconstruction and reconstruction imaging, 18 and computed tomography angiography (CTA).…”