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Erschienen in:
01.03.2013 | Original Article
Conservative treatment for isolated superior mesenteric artery dissection
Erschienen in: Surgery Today | Ausgabe 3/2013
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Purpose
The treatment guidelines for isolated superior mesenteric artery (SMA) dissection have not been established. We assessed 14 cases of SMA dissection and reviewed the literature on this entity.
Methods
The subjects were 11 men and 3 women (average age 64 years), with SMA dissection diagnosed by computed tomography (CT) scan or digital subtraction angiography, between 2001 and 2009, at our institution. Eight patients presented with symptoms such as abdominal pain, but SMA dissection was diagnosed incidentally during investigations of another illness in six patients. Thirteen patients were treated conservatively with anticoagulation and/or antiplatelet drugs, but one underwent exploratory laparotomy. The median follow-up period was 22 months.
Result
The symptoms did not worsen, and ultimately resolved in the eight patients who had symptoms. Isolated dissection improved dramatically in two of the six patients with obstruction of the false lumen and was not seen on computed tomography (CT) scans 1 and 3 months after its onset.
Conclusion
We recommend conservative treatment as the first choice for isolated SMA dissection, even if the patient has abdominal pain and tenderness, given that there are no signs of peritonitis.