2020 Volume 53 Issue 7 Pages 592-597
We report a case of a 49-year-old man with isolated acute superior mesenteric artery (SMA) dissection with mesenteric ischemia. He was admitted due to sudden abdominal pain. CT showed SMA dissection from its origin and obstruction of SMA from the root of the middle colic artery (MCA). Because bowel ischemia was suspected, we performed laparotomy. Though laparotomy showed the small intestine with a slight ischemic change, the blood flow was sensed by pulsed ultrasonic doppler, so resection of the small intestine was not performed. However, CT showed emphysema in the ascending colon wall the next day, therefore necrosis of the colon was suspected and an emergency operation was performed. SMA was obstructed from the root of the MCA to all the branches. After right hemi-colectomy, end-to-end anastomoses were performed between RGEA and 3rd jejunal artery, the right branch of MCA and the ileocolic artery for avoiding widespread bowel necrosis. Though he required two operations for necrosis of the intestine, perfused from 2nd jejunal artery and perforation of the intestine, the patient was discharged on the 74th postoperative day. Reconstruction of the branch of SMA with right gastroepiploic artery and middle colic artery for isolated acute superior mesenteric artery dissection can be considered as a useful approach for avoiding intestinal necrosis.
