Spontaneous isolated dissection of the superior mesenteric artery (original) (raw)
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Spontaneous dissection of coeliac and superior mesenteric artery: double whammy
Case Reports, 2021
Isolated dissection of one of the mesenteric arteries without concurrent involvement of the aorta is a rare clinical entity and an unusual cause of abdominal pain. It usually involves one artery, most commonly the superior mesenteric artery (SMA) followed by the coeliac artery. We are reporting a rare case where both coeliac and SMA were showing dissection. We are reporting a case of 60-year-old hypertensive male who came with worsening abdominal pain for 5 days; CT scan showed coeliac and SMA dissection without any imaging evidence of intestinal ischaemia. He was successfully managed medically with bowel rest and anticoagulation. Two weeks of follow-up CT scan showed no progression or thrombus formation. For complicated cases, percutaneous transluminal angioplasty of a visceral artery or open surgical exploration or hybrid approach is required. However, for stable uncomplicated cases, medical therapy alone is sufficient.
JOURNAL OF CLINICAL AND DIAGNOSTIC RESEARCH, 2016
A 42-year-old Tunisian man was presented to the emergency department with acute epigastric pain, nausea and vomiting. He was a smoker and had a past medical history of hypertension. On physical examination, there was no evidence of peritonitis and vital signs were normal. Laboratory data revealed leukocytosis with a white blood cell count of 11,000/ml. There was no evident pathology in the abdominal sonographic examination. An abdominal computed tomography scan with intravenous contrast showed a normal thoraco-abdominal aorta. However, dissection of both the celiac trunk and SMA was determined. SMA dissection was classified as Sakamoto type II b. There was no bowel oedema or free fluid. The dissection of the celiac artery was approximately 22mm long with aneurysmal dilatation [Table/Fig-1-3] with partial thrombosis causing moderate narrowing. Dissection of SMA was extending for approximately 1.8cm, accompanied by contrast accumulation in the wall due to ulceration in the proximal part of the artery. SMA was visualized as 60% narrowed because of the dissection [Table/Fig-4-6]. Inferior Mesenteric Artery (IMA) and renal arteries were normal. Conservative treatment was
Introduction: Acute mesenteric ischemia is deadly from 50% to 90% of cases due to poor understanding of the clinical picture of abdominal pain and the differential diagnosis when it is not suspected and partly because of an unacceptable delay in making the diagnosis. Clinical case: A 31-year-old female with generalized abdominal pain without peritoneal irritation accompanied by vomiting and loose bowel movements. Vital signs: BP 90/70 mmHg, HR 100/min, BF 20/min, Temperature 96.8°F. Laboratory test: Bh: Hto. 39.4, 42.6/103 leukocytes/uL, 89% neutrophils, 10% lymphocytes; QS: glucose
Superior Mesenteric Artery Syndrome: A Forgotten Cause of Duodenal Obstruction
Cureus, 2020
Superior mesenteric artery (SMA) syndrome has been described in medical literature as a rare cause of duodenal occlusion. It has a varied presentation, with distressing gastrointestinal symptoms such as nausea, abdominal pain, and further weight loss. Several conditions contribute to duodenal obstruction in SMA syndrome. We present a case of SMA syndrome in a patient with malignant breast cancer who presented with sudden onset of severe nausea and voluminous vomiting. Various imaging studies revealed a distended proximal intestine with a transition point in the third part of the duodenum. The patient was managed conservatively with nasogastric decompression and fluid electrolyte management, leading to symptomatic relief.
International Surgery Journal, 2019
Superior mesenteric artery (SMA) syndrome (also known as Wilkie’s syndrome) is an unusual cause of proximal intestinal obstruction, attributable to vascular compression of the third part of duodenum between the superior mesenteric artery and the abdominal aorta due to acute angulation of SMA. It is a life threatening disease as it poses a diagnostic dilemma and often diagnosed by exclusion of other causes. It is an acquired disorder and is commonly due to loss of fatty tissue as a result of a variety of debilitating conditions. We report a case of SMA syndrome in a 23 year young asthenic female patient, with a long history of recurrent abdominal pain, epigastric fullness, voluminous vomiting, and weight loss. Symptoms persisted for 1 year and the patient underwent extensive investigations, but to no avail. Thereafter she developed proximal intestinal obstruction, which unravelled her diagnosis. Abdominal examination revealed epigastric fullness, tenderness and hyper peristaltic bowe...
Isolated Spontaneous Dissection of the Celiac Artery: Report of Two Cases
Annals of Vascular Diseases, 2014
Isolated spontaneous dissection of the splanchnic arteries is rare. Among these disorders, dissection of the celiac artery (DCA) is especially rare. Obon-Dent 1) reported that only 33 reported cases of DCA were yielded by a Medline database search in 2012. The patients were treated by surgery, endovascular intervention and medical management in these reports, but the therapeutic strategy is still unclear and controversial. We report two cases of DCA, in which the patients were treated conservatively and observed carefully. Case Report Case 1 A 58-year-old male smoker underwent enhanced computed tomography (CT) because of mild right hypogastralgia of 10-day duration and elevation of carcinoembryonic antigen (8.9 ng/mL) and carbohydrate antigen 19-9 (124 U/mL). He had had no episode of severe back or abdominal pain. Enhanced CT revealed solitary dissection of the celiac trunk, in which the common hepatic artery arose from the true lumen whereas the splenic artery arose from the false lumen (Fig. 1). He was admitted for further investigation. On admission, blood pressure was 134/72 mmHg and he had mild tenderness in the epigastrium and right hypogastrium, which gradually resolved over several days. Laboratory data showed slight elevation of white blood cell count (10100/µL) and hemoglobin (16.8 g/dL), but C-reactive protein (CRP) was normal. Esophagogastroduodenoscopy and total colonoscopy showed no pathological change except atrophic gastritis. He was orally administered a β-blocker to decrease blood pressure mildly, but no antiplatelet or anticoagulant drugs, and was discharged nine days after admission.
Spontaneous celiacomesenteric trunk dissection: Case report
International Journal of Surgery Case Reports, 2020
INTRODUCTION: The celiacomesenteric trunk (CMT) is one of the most striking among the different variations of the normal vascularisation of the gastro-intestinal tract. It is often accidentally discovered during autoptical dissections, angiography or abdominal computed tomography (CT). CASE PRESENTATION: A 27-year-old man was admitted to emergency for an acute abdominal pain. For his critical condition, the patient was immediately brought to the operating room. A extensive intestinal necrosis was found. Post-operator CT discovered a common CMT that is complicated by extended thrombosis. Despite all resuscitation measures, the patient died of septic shock two days later. An autopsy was performed showed that the main cause of intestinal ischemia was related to dissection of a common CMT. DISCUSSION: A CMT is a highly unusual variation in humans. It is usually asymptomatic and may be discovered incidentally during vascular surgery, radiologic imaging, or cadaver's dissection. Lesion of this entity can lead to serious gastrointestinal complications including necrosis. Different classifications are proposed in the literature. CONCLUSION: As it is associated with the risk of mesenteric ischaemia, CMT should be kept in mind as a differential diagnosis for cases of recurrent non-specific abdominal pain.
Superior Mesenteric Artery Syndrome: An Unusual Cause Of Duodenal Obstruction
VITAE Academia …
Superior mesenteric artery (SMA) arising from aorta at the level of first lumbar vertebra usually takes an angular downward course from ventral surface of aorta. It is through this vascular angle that the 3rd part of duodenum passes at the level of 4th lumbar vertebra. Fat and lymphatics around SMA maintains the angle at 25° to 60° with a mean of 45 0 and provide protection against duodenal compression. In Superior Mesenteric Artery Syndrome, the SMA-aorta angle in narrowed down to 7° to 22° with a mean of 8 0 leading to entrapment of the transverse part of duodenum between the artery and the vertebral column and aorta with resultant partial or complete duodenal obstruction. We report a case of Superior Mesenteric Artery Syndrome which was diagnosed by CECT abdomen. Duodeno-jejunostomy was done to treat this condition.