Acute and Isolated Dissection of the Superior Mesenteric Artery: Presentation and follow-up with Duplex Ultrasound

Abstract

Introduction

Isolated dissection of the superior mesenteric artery (SMA) is a rare and often-fatal condition. Currently, only 47 cases of SMA dissection, in the absence of aortic dissection, have been reported in the literature. This report describes a case wherein the use of duplex ultrasound (DU) established the initial diagnosis and was used aggressively in follow-up care.

Case Report

A 51-year-old man presented to the emergency department (ED) complaining of severe abdominal pain. A DU of the mesenteric vessels was normal with the exception of a focal dilatation noted near the origin of the SMA that was later confirmed by computed tomography. Two days after admission, a second DU revealed a further increase in diameter of the proximal SMA and an intimal flap present in this segment. The patient was managed conservatively and discharged. Approximately 1 year later, the patient returned to the ED complaining of nausea and diarrhea for 3 weeks. DU revealed chronic dissection of the SMA as well as a stenosis in the celiac artery and inferior mesenteric artery (IMA). A stent was placed into the origin of the IMA to ensure collateral blood flow and anticoagulant therapy was continued. Before discharge, another DU was performed, which showed a patent IMA and well-perfused proximal SMA. One week later, the patient was asymptomatic and discharged home.

Conclusions

The use of DU provided a prompt and accurate diagnosis for a rare and unsuspected abnormality in the SMA that proved to be very beneficial in follow-up management decisions.