Clinical Features of Spontaneous Isolated Superior Mesenteric Artery Dissection

Ko,  Mi Hee; Kim,  Gab Teog; Oh,  Yong Hae

J Korean Soc Emerg Med > Volume 24(6); 2013 > Article

Original Article

Journal of The Korean Society of Emergency Medicine 2013;24(6): 716-723.

Clinical Features of Spontaneous Isolated Superior Mesenteric Artery Dissection

Mi Hee Ko, Gab Teog Kim, Yong Hae Oh

Department of Emergency Medicine, College of Medicine, Dankook University, Chunan, Korea. gtkim@dankook.ac.kr

ABSTRACT

PURPOSE:
Spontaneous isolated superior mesenteric artery dissection (SISMAD) is defined as superior mesenteric artery (SMA) dissection without an associated aortic dissection. SISMAD is an uncommon mesenteric ischemia, but can lead to death if not recognized early. Here, we present our experience on features characterizing SISMAD in an early period and review imaging findings.
METHODS:
Twelve symptomatic SISMAD patients who received conservative treatment between March 2005 and February 2012 were included in this study. Their clinical characteristics, imaging findings, treatment methods and outcomes were retrospectively analyzed. A diagnosis of SISMAD was confirmed by multidetection computed tomography (MDCT) and computed tomographic (CT) angiography.
RESULTS:
All patients complained of severe (6 patients) or moderate abdominal pain (6 patients), and 4 patients complained of radiating back pain at the same time. Eight patients had an acute onset (< or =3 days) of abdominal pain, and 4 patients had a chronic onset of the abdominal pain. The abdominal pain was located in the upper abdomen in 7 patients and in the periumbilical area in 5 patients. Angiographic types of SISMAD were classified into Sakamoto's type I (3 patients), type II (1), type III (4), and type IV (4). The dissection occurred within 3 cm from the orifice of the SMA in 9 patients (75%). The angiographic type of SISMAD was not associated with clinical symptoms and treatment methods. Ten out of 12 patients were treated with conservative management such as expectation and anticoagulation. Aneurysmal dilation of the SMA was noted in 4 patients, and 2 patients out of these 4 underwent surgical operations due to persistent abdominal pain and a growing aneurysm. No patients had a recurrence of symptoms and lesion progression on follow-up CT angiography.
CONCLUSION:
Patients with an acute onset of severe abdominal pain or chronic persistent abdominal pain should be suspicious of SISMAD and CT angiography should be performed.

Key words: Superior mesenteric artery, Dissection, Computed tomography