kjg The Korean Journal of Gastroenterology Korean J Gastroenterol 1598-9992 2233-6869 The Korean Journal of Gastroenterology 10.4166/kjg.2010.55.1.58 kjg-55-58 Original Article Isolated Spontaneous Dissection of Superior Mesenteric Artery: Treated by Percutaneous Endovascular Stent Placement KwakJae Wuk M.D. PaikChang Nyol M.D. LeeKang Moon M.D. ChungWoo Chul M.D. JungSung Hoon M.D. KimJi Eun M.D. BaikJun Hyun M.D. ∗ YangJin Mo M.D. Department of Internal Medicine, College of Medicine, The Catholic University of Korea, Seoul, Korea Department of Radiology, College of Medicine, The Catholic University of Korea, Seoul, Korea Correspondence to: Chang Nyol Paik, M.D. Department of Gastroenterology, Catholic University Saint Vincent's Hospital, 93-6, Ji-dong, Paldal-gu, Suwon 442-723, Korea Tel: +82-31-249-7138, Fax: +82-31-249-7137 E-mail: cmcu@catholic.ac.kr 22010 2122010 551 5861 18082009 22082009 Copyright © 2010 The Korean Journal of Gastroenterology 2010 Abstract

Isolated spontaneous dissection of the superior mesenteric artery (SMA) without aortic dissection is a rare cause of acute mesenteric ischemia. A sudden decrease of intestinal blood flow can lead to fatal complications such as ischemic necrosis, shock, and death. Therefore, early diagnosis and therapeutic approach before the occurrence of intestinal infarction are the most important factor to determine the patient's prognosis. A 52-year-old male presented with postprandial periumbilical pain, and isolated spontaneous dissection of the superior mesenteric artery with mural thrombus was detected by abdominal computed tomography with contrast enhancement. By the percutaneous implantation of vascular metallic stent via femoral artery, he was treated successfully. We report a case of isolated spontaneous dissection of the SMA treated by a percutaneous endovascular stent replacement with a review of literature.

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Contrast-enhanced abdominal CT scan findings. (A) A Intimal flap in the superior mesenteric artery (SMA) separating two lumen (white arrow). (B) A partial intraarterial low density thrombus in the proximal portion of the SMA without aortic dissection was demonstrated (white arrow).

SMA angiography findings. (A) A dissection of proximal superior mesenteric artery was noted (white arrow). (B) A dissection of SMA was located about 2 cm distal to SMA orifice and the collapse of true lumen was showed (white arrow).

SMA angiography finding after the stent insertion. A 6-40-mm self-expandible stent was placed covering the opening of the intimal flap (white arrows).