Abstract
A 59-year-old male with excruciating abdominal pain was transported to the emergency room of local hospital. In spite of an intramuscular injection of 20 mg of scopolamine, his abdominal pain was not improved. Thereafter, the patient was transferred to another hospital and was found to have a dissection of the superior mesenteric artery. To obtain a more detailed diagnosis and select further treatments, he was again transported, this time to our emergency department. On arrival, his vital signs were stable except for high blood pressure. A detailed CT examination revealed a superior mesenteric artery dissection associated with thrombus formation, however, the blood flow to the distal organs was preserved. Based on these findings, we selected conservative treatments with cilostazol and cilnidipine. Follow-up CT examinations performed on the 3rd and 6th hospital days showed no changes in the dissection in comparison with the images observed on his admission CT. Based on these follow-up CTs, and the stable physical symptoms of the patient, we allowed him to start oral intake and to be discharged from the hospital on the 11th hospital day. A CT examination performed two months after the incident showed that the false lumen was almost completely thrombosed, but that the size of the true lumen was narrower. A CT examination performed on six months after the incident showed that the false lumen was completely thrombosed, and the size of the false lumen was smaller, while the size of the true lumen was larger. The dissection of the superior mesenteric artery did not recur in this case. Idiopathic superior mesenteric artery dissection is very rare, but should be kept in mind when a patient presents with acute abdominal pain.
