A Spontaneous Isolated Superior Mesenteric Artery Dissection Associated with Cocaine Abuse: A Pathomechanistic Association.

Jeffrey Sobecki,Robert A Palma,Rayan S El-Zein,Roy Greenberg,Michael Keleher

doi:10.1155/2020/2514687

Abstract

Spontaneous isolated superior mesenteric artery dissection (SISMAD) is a rare potentially fatal disease. We present a case of cocaine-related SISMAD in a patient with abdominal pain. A 38-year-old African American male with hypertension and alcohol, cocaine, and tobacco abuse presented with abdominal pain and recent cocaine use. A CT angiogram revealed SISMAD; he was treated with conservative management. Cocaine and SISMAD share similar pathophysiologic mechanisms pertaining to vascular smooth muscle cell apoptosis and increased shear stress at fixed vascular positions. Our report emphasizes the need to consider cocaine abuse in SISMAD pathophysiology, risk stratification, and treatment algorithms in future studies.

Highlights

Reported by Bauersfeld in 1947, spontaneous isolated superior mesenteric artery dissection (SISMAD) is a rare but potentially fatal arterial disease with an incidence of 0.06% from a cohort of 6666 autopsies [1]
While cocaine use has been associated with other mesenteric pathology, cocaine-related SISMAD remains a rare finding
Clinical presentations can range from an asymptomatic incidental finding to severe abdominal pain from bowel ischemia or fatal aneurysmal rupture

Summary

Introduction

Reported by Bauersfeld in 1947, spontaneous isolated superior mesenteric artery dissection (SISMAD) is a rare but potentially fatal arterial disease with an incidence of 0.06% from a cohort of 6666 autopsies [1]. Prior to 2001, only 46 cases were reported; since 2016, more than 622 cases have been reported [2] reflecting the advancement of imaging rather than prevalence. Multiple risk factors have been suggested such as arteriopathy (connective tissue diseases, cystic medial necrosis, etc.), tobacco use, atherosclerosis, alcohol abuse, obesity, heavy weight lifting, and pregnancy [3]. While cocaine use has been associated with other mesenteric pathology (ischemia, perforation), cocaine-related SISMAD remains a rare finding

Case Report

Findings

Discussion