Type 3 intestinal failure after bypass grafting for isolated acute superior mesenteric artery dissection: A case report

Abstract

Isolated superior mesenteric artery (SMA) dissection is a very rare cause of mesenteric ischemia. A 66-year-old male patient was admitted to our emergency department with severe epigastric pain. He was diagnosed with spontaneous SMA dissection leading to intestinal ischemia. A bypass graft was used to relieve acute ischemia with an initial success. However, this success was not sustained, as the graft failed slowly despite a satisfactory technical appearance, leading to type 3 intestinal failure which could be explained by the competitive flow. In conclusion, bypass grafting may yield short-term bowel viability in the treatment of isolated SMA dissection and acute ischemia; however, grafts may fail without radiologically apparent technical complications possibly due to the competitive flow from the collateralizing circuits.

Detecting isolated superior mesenteric artery dissection with computed tomography

“…Acute mesenteric ischemia causes acute abdominal pain and isolated dissection of SMA rarely causes this condition [3,4]. SMA dissection can be classified into three types: Type I: A patent true lumen exists alongside a patent false lumen with reentry, Type II: A patent true lumen exists alongside an either patent (Type IIa) or thrombosed (Type IIb) false lumen without re-entry, and Type III: Both lumens are thrombosed [5,6].…”