2022 Volume 55 Issue 7 Pages 456-463
Isolated dissection of the superior mesenteric artery (SMA) is a rare disease for which no cure has been established. We report a case in which ischemic enteritis persisted and required reoperation after surgery and stent placement. A 38-year-old man underwent surgery for isolated SMA dissection and poor intestinal angiography on contrast-enhanced CT. After a stent was placed in the SMA and the abdomen was opened, the right colon was found to be necrotic, but there was no necrosis in the small intestine. Right hemicolectomy was performed and an ileal stoma and transverse colon mucoid fistula were constructed, but high fever and abdominal pain persisted. Contrast-enhanced CT showed blood flow in the SMA and small intestine, but extensive small bowel edema was noted. Conservative treatment was continued because of ischemic enteritis, but the small intestine had to be additionally resected 56 days after surgery because the general condition worsened. Thereafter, the condition of the patient improved and he was discharged 113 days after the first operation. This case suggests that surgery should be considered if ischemic enteritis persists after SMA revascularization and avoidance of intestinal necrosis.
