Abstract
We have experienced two cases of idiopathic superior mesenteric artery dissection treated by combination of anti-coagulant and thrombolytic therapies.
Patient 1, a 55-year-old man, presented with periumbilical pain. An abdominal contrast-enhanced CT scan and abdominal angiography demonstrated a dissection of the superior mesenteric artery at about 1 cm distal from the ostium. Continuous intraarterial infusion of urokinase through a catheter placed in the artery and systemic administration of heparin were started. Angiography performed again on the 6th hospital day revealed disappearance of thrombus in the false lumen. The patient has been followed in our clinic and no recurrence of symptoms has occurred up to now.
Patient 2, a 49-year-old man, presented with epigastralgia. An abdominal contrast-enhanced CT scan demonstrated a dissection of the superior mesenteric artery from the ostium and thrombus which filled the false lumen. After aspiration of the thrombus under angiography, continuous intraarterial urokinase infusion therapy was started. The patient was discharged with marked improvement on the 14th hospital day.
Recent progression of imaging diagnosis has enabled us to make early diagnosis as well as to start early treatment of idiopathic superior mesenteric artery dissection. Combined use of anti-coagulant and thrombolytic therapies can be a beneficial therapy for the disease in a slight degree.
