Abstract
BackgroundIsolated dissection of the superior mesenteric artery (IDSMA) remains a rare diagnosis. However, new diagnostic means such as computed tomography makes it possible to detect even asymptomatic patients. If patients present symptomatic on admission, the risk of bowel infarction makes immediate therapy necessary. Today, endovascular techniques are often successfully used; however, open surgery remains important for special indications. In this paper, we present two cases with IDSMA and show why open surgical repair is still important in current treatment concepts.MethodsTwo cases with ISDMA that presented in our department from January 1, 2014 to June 1, 2014 are described. Data collection was performed retrospectively. Additionally, a review of articles which reported small cases series on patients with IDSMA within the past five years is provided.ResultsBoth patients underwent open surgical repair following interdisciplinary consultation. Both patients were transferred to the intensive care unit after surgical repair and needed bowel rest, nasogastric suction and intravenous fluid therapy. CT scans were performed within the first week after operation. Platelet aggregation inhibitors were used in both cases as postoperative medication. Both patients survived and are able to participate in everyday activities.ConclusionOpen surgical repair remains important in cases of anatomic variants of visceral arteries and suspected bowel infarction. Therefore, it is important that knowledge about open surgical techniques still be taught and trained.
Highlights
Isolated dissection of the superior mesenteric artery (IDSMA) remains a rare diagnosis; following the implementation of Computed tomography (CT)-scans in clinical routines, an increasing number of reports concerning patients with IDSMA can be observed [1]
The entry of the dissection is mostly located at the beginning of the superior mesenteric artery (SMA), i.e., about 15 mm to 30 mm of its origin, as in this area, differential forces as a result of the transition of the fixed to the mobile segment of the artery are the highest [7,10]
We present two cases where initial open surgery had to be performed due to abnormal vascular anatomy and a complete occlusion of the dissected SMA
Summary
Isolated dissection of the superior mesenteric artery (IDSMA) remains a rare diagnosis; following the implementation of CT-scans in clinical routines, an increasing number of reports concerning patients with IDSMA can be observed [1]. The superior mesenteric artery (SMA) is involved in over 60% of all spontaneous visceral dissections; its isolated dissection remains uncommon [3]. We present two cases where initial open surgery had to be performed due to abnormal vascular anatomy and a complete occlusion of the dissected SMA. Isolated dissection of the superior mesenteric artery (IDSMA) remains a rare diagnosis. If patients present symptomatic on admission, the risk of bowel infarction makes immediate therapy necessary. Endovascular techniques are often successfully used; open surgery remains important for special indications. We present two cases with IDSMA and show why open surgical repair is still important in current treatment concepts
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