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• W2913206927 abstract "Acute abdominal pain secondary to mesenteric ischemia caused by spontaneous superior mesenteric artery (SMA) dissection, with no other abnormality or aortic dissection, is unusual. There have been about 56 cases reported since 1947. However, there have been very few reported cases in literature of accelerated hypertension causing isolated SMA dissection in a female. We report a case of spontaneous, isolated SMA dissection, not involving the aorta or the SMA origin, which was managed conservatively in a female patient. A 51-year-old female with past medical history of cholecystectomy presented with diffuse abdominal pain that radiated to the back. It was associated with nausea, and one episode of vomiting. Patient was noted to have a blood pressure of 226/111 mmHg. On physical exam, patient was inconsolable and writhing in pain. She had decreased bowel sounds, but had a soft, non-tender abdomen to palpation. Patient had lactate level of 0.7 mmol/L. Computed tomography (CT) angiogram of the chest/abdomen/pelvis with contrast showed SMA dissection. Patient was managed with IV narcotics, IV heparin, and IV esmolol with a target systolic blood pressure goal < 120 mmHg. Lactate remained within normal limits. Repeat CT angiogram of chest/abdomen/pelvis on day 3 of hospitalization was ordered which showed no change in size of the dissection. Patient was switched to oral antihypertensives. We chose to stop heparin and start aspirin and clopidogrel. Patient's abdominal pain had subsided after aggressive blood pressure control. She was discharged with instructions to follow up with subsequent CT scans if symptoms persist. The pathogenesis behind the case in our patient appears to be that the accelerated hypertension caused high stress on the wall of the superior mesenteric artery at the inferior pancreatic edge causing dissection. The hypothesis from Solis et al states that this type of dissection appears to cause transient mesenteric ischemia causing abdominal pain. Other proposed etiologies of SMA dissection include atherosclerosis, fibrodysplasia, trauma, and connective tissue disorders. Suzuki et al reports that CT angiography is the appropriate imaging modality to investigate SMA dissections. It appears that there is no clear treatment protocol for SMA dissection. There are options for surgery, endovascular stenting, and conservative management. Patients managed conservatively should be followed up closely to look for signs of worsening mesenteric ischemia.FigureFigureFigure" @default.
• W2913206927 created "2019-02-21" @default.
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• W2913206927 date "2017-10-01" @default.
• W2913206927 modified "2023-09-27" @default.
• W2913206927 title "Isolated Superior Mesenteric Artery Dissection: An Uncommon Cause of Abdominal Pain" @default.
• W2913206927 doi "https://doi.org/10.14309/00000434-201710001-02408" @default.
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