Emara Salma, Kropp Madison, Akbari Masoud, Cook Kristin
Department of Medicine, Rowan University School of Osteopathic Medicine, Stratford, NJ 08043, United States.
Department of Surgery, Hackensack Meridian Palisades Medical Center 7600 River Road, North Bergen, NJ 07047, United States.
J Surg Case Rep. 2024 Dec 18;2024(12):rjae789. doi: 10.1093/jscr/rjae789. eCollection 2024 Dec.
Isolated superior mesenteric dissection (ISMAD) is an uncommon condition, often diagnosed incidentally for presentations of acute abdominal pain. Early identification and treatment are crucial as complications such as bowel ischemia or vessel rupture can occur. There remain no established treatment guidelines, making surgical and endovascular indications controversial. A 60-year-old male presented with acute abdominal pain, and was diagnosed with ISMAD via computed tomography imaging. He was initially managed conservatively which progressed to worsening abdominal pain, hypertensive crisis, and hemoperitoneum on follow-up computed tomography angiography (CTA). A mesenteric angiogram revealed a pseudoaneurysm in the superior mesenteric artery (SMA) which was subsequently treated with coil embolization. The absence of long-term evidence on relapse rates questions the overall effectiveness of nonoperative therapy. Further research is needed to establish clear guidelines and to determine whether early intervention might be more advantageous in managing complications and preventing recurrence.
孤立性肠系膜上动脉夹层（ISMAD）是一种罕见疾病，常因急性腹痛就诊而偶然被诊断。由于可能发生肠缺血或血管破裂等并发症，早期识别和治疗至关重要。目前尚无既定的治疗指南，使得手术和血管内治疗指征存在争议。一名60岁男性因急性腹痛就诊，经计算机断层扫描成像诊断为ISMAD。他最初接受保守治疗，但在后续的计算机断层扫描血管造影（CTA）检查中病情进展为腹痛加重、高血压危象和腹腔积血。肠系膜血管造影显示肠系膜上动脉（SMA）存在假性动脉瘤，随后接受了弹簧圈栓塞治疗。缺乏关于复发率的长期证据，这对非手术治疗的总体有效性提出了质疑。需要进一步研究以建立明确的指南，并确定早期干预在处理并发症和预防复发方面是否可能更具优势。
