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

Isolated dissection of the superior mesenteric artery is rare; it is predominantly observed in men with the highest incidence in those over 40 years old. Contrast-enhanced multi-detector computed tomography is considered essential for the diagnosis, therapeutic management and follow-up. The therapeutic approach ranges from conservative medical treatment to surgery or endovascular stent placement, but there are, to date, no approved guidelines. We report the case of a 68-year old man who entered our Emergency Department just for mild abdominal pain, which later proved to be due to acute dissection of the superior mesenteric artery. was required because of suspected gastrointestinal (cecal) neoplasm. The contrast agent used for intravenous injection was iodixanol a water-soluble nonionic contrast medium (containing 320 mg of iodine per milliliter). An 18-gauge needle with cannula was used to administered 120 mL of iodixanol intravenously, followed by 40 mL of normal saline, using a dual headed pressure injector at a flow rate of 3.5 mL/sec. Arterial and venous phase images were obtained using the bolus tracking technique, with the region of interest in the abdominal aorta at the level of the celiac artery (threshold=150 HU). Finally, sagittal, coronal and curved multiplanar reconstructions were made. MDCT showed that the diameter of the SMA was enlarged (12 mm) and identified the vessel’s true and false lumina by the presence of an intimal flap just 15 mm after the origin of the SMA (Figures 1 and 2). The dissection extended anterogradely for 46 mm (Figure 3) and a modest amount of fluid at the origin of SMA was detected. There were no signs of bowel ischemia or ascites. The patient started therapy with enoxaparin 6000 IU once daily; after 1 month of this therapy, the MDCT showed no meaningful changes, with the exception of reabsorption of the previously reported modest amount of fluid at the origin of the SMA.