Clinical Communication: Adults| Volume 39, ISSUE 5, P576-578, November 2010

Spontaneous Superior Mesenteric Artery (SMA) Dissection: An Unusual Cause of Abdominal Pain


      A 44-year-old woman presented to our Emergency Department with a 4-day history of severe, sharp left upper quadrant abdominal pain associated with nausea and vomiting. She had been seen 3 days prior at another Emergency Department, and had a negative work-up including a normal non-contrast computed tomography (CT) scan of the abdomen/pelvis for possible kidney stone. Vital signs were: temperature 36.3°C (97.3°F), pulse 100 beats/min, respiratory rate 18 breaths/min, and blood pressure 141/80 mm Hg. Physical examination was remarkable for marked tenderness in the left upper and middle quadrants and voluntary guarding. Bowel sounds were normal. Although laboratory studies were normal, a CT scan of the abdomen/pelvis with intravenous contrast suggested a superior mesenteric artery dissection. This was confirmed with arteriography. The clinical presentation, diagnostic evaluation, and management of superior mesenteric artery dissection are reviewed.


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        • Suzuki S.
        • Furui S.
        • Kohtake H.
        • et al.
        Isolated dissection of the superior mesenteric artery: CT findings in six cases.
        Abdom Imaging. 2004; 29: 153-157
        • Gouëffic Y.
        • Costargent A.
        • Dupas B.
        • Heymann M.F.
        • Chaillou P.
        • Patra P.
        Superior mesenteric artery dissection: case report.
        J Vasc Surg. 2002; 35: 1003-1005
        • Miyamoto N.
        • Sakurai Y.
        • Hirokami M.
        • et al.
        Endovascular stent placement for isolated spontaneous dissection of the superior mesenteric artery: report of a case.
        Radiat Med. 2005; 23: 520-524
        • Sparks S.
        • Vasquez J.C.
        • Bergan J.J.
        • Owens E.L.
        Failure of nonoperative management of isolated superior mesenteric artery dissection.
        Ann Vasc Surg. 2000; 14: 105-109
        • Yoon Y.W.
        • Choi D.
        • Cho S.Y.
        • Lee D.Y.
        Successful treatment of isolated spontaneous superior mesenteric artery dissection with stent placement.
        Cardiovasc Intervent Radiol. 2003; 26: 475-478
        • Chang S.H.
        • Lien W.C.
        • Liu Y.P.
        • Wang H.P.
        • Liu K.L.
        Isolated superior mesenteric artery dissection in a patient without risk factors or aortic dissection.
        Am J Emerg Med. 2006; 24: 385-387
        • Picquet J.
        • Abilez O.
        • Pénard J.
        • Jousset Y.
        • Rousselet M.C.
        • Enon B.
        Superficial femoral artery transposition repair for an isolated superior mesenteric artery dissection.
        J Vasc Surg. 2005; 42: 788-791
        • Nakamura K.
        • Nozue M.
        • Sakakibara Y.
        • et al.
        Natural history of spontaneous dissecting of aneurysm of the proximal superior mesenteric artery: report of a case.
        Surg Today. 1997; 27: 272-274
        • Vignati P.
        • Welch J.P.
        • Ellison L.
        • Cohen J.L.
        Acute mesenteric ischemia caused by isolated superior mesenteric artery dissection.
        J Vasc Surg. 1992; 16: 109-112
        • Corbetti F.
        • Vigo M.
        • Bulzacchi A.
        • Angelini F.
        • Burigo E.
        • Thiene G.
        CT diagnosis of spontaneous dissection of the superior mesenteric artery.
        J Comput Assist Tomogr. 1989; 13: 965-967
        • Dushnitsky T.
        • Peer A.
        • Katzenelson L.
        • Strauss S.
        Dissecting aneurysm of the superior mesenteric artery: flow dynamics by color Doppler sonography.
        J Ultrasound Med. 1998; 17: 781-783