Gao Dong-Na, Qi Qing-Hui, Gong Ping
aEmergency Department bDepartment of Abdominal Emergency, the First Affiliated Hospital of Dalian Medical University, Dalian, China.
Medicine (Baltimore). 2017 Nov;96(46):e8598. doi: 10.1097/MD.0000000000008598.
Spontaneous isolated dissection of the superior mesenteric artery (SID-SMA) is a rare arterial disease that is difficult to differentiate from other diseases because of lack of specific clinical manifestation and for which there is no available optimal management strategy.
A 58-year-old male patient visited our emergency room with sudden onset of moderate-severe epigastric abdominal pain of uncertain cause.
Computed tomography scanning showed a characteristic "double lumen sign" of the superior mesenteric artery, and further computed tomography angiography findings revealed a dissected segment of the superior mesenteric artery.
Conservative management was administered for 5 days, but the abdominal pain remained. Subsequently, an endovascular stent was placed in the affected superior mesenteric artery. Postoperative antiplatelet therapy was administered for 6 months.
The abdominal pain was relieved. Six months later, a follow-up of computed tomography angiography showed that the stent placed had no interval narrowing.
Based on our review and the illustration of this case, endovascular stenting may be a preferred rescue treatment in SID-SMA patients for whom initial conservative treatment fails.
自发性孤立性肠系膜上动脉夹层（SID - SMA）是一种罕见的动脉疾病，由于缺乏特异性临床表现，难以与其他疾病相鉴别，且尚无可用的最佳治疗策略。
一名58岁男性患者因原因不明的突发中重度上腹部腹痛前来我院急诊室就诊。
计算机断层扫描显示肠系膜上动脉具有特征性的“双腔征”，进一步的计算机断层血管造影结果显示肠系膜上动脉有一段夹层。
进行了5天的保守治疗，但腹痛仍未缓解。随后，在受影响的肠系膜上动脉置入了血管内支架。术后进行了6个月的抗血小板治疗。
腹痛缓解。6个月后，计算机断层血管造影随访显示置入的支架没有出现节段性狭窄。
根据我们对该病例的回顾及说明，对于初始保守治疗失败的SID - SMA患者，血管内支架置入术可能是一种首选的挽救治疗方法。
