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Management of isolated spontaneous dissection of superior mesenteric artery

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Abstract

Purpose

Our objectives were to clarify the management of isolated spontaneous dissection of the superior mesenteric artery (DSMA).

Methods

We reviewed seven patients diagnosed as having DSMA from 2002 to 2007 (group A). Simultaneously, we analyzed 50 cases of DSMA previously reported in the literature between 2000 and 2008 (group B). In each group, clinical presentation, Sakamoto’s classification, imaging appearances, need for emergent surgery, failure of medical management, and long-term outcome were analyzed.

Results

In group A, according to Sakamoto’s classification, there were two type I, two type II, and three type III. Two patients needed surgery (one type II, one type III). In group B, according to Sakamoto’s classification, there were seven type I, five type II, 14 type III, and six type IV. Intestinal revascularization was necessary for 21 patients, especially for types II and III, while medical management was more frequent for types I and IV. We identified four indications for intestinal revascularization: acute mesenteric ischemia with mesenteric thrombosis, arterial rupture, chronic mesenteric ischemia with superior mesenteric artery (SMA) stenosis, and SMA dissecting aneurysm of at least 2 cm in diameter. If abdominal pain lasts for more than 1 week, types I and IV were able to be medically managed, whereas intestinal revascularization has to be considered in types II and III.

Conclusion

Patients with symptoms lasting for more than 1 week, aneurysmal dilatation more than 2 cm in diameter, and SMA stenosis are suitable candidates for surgical management.

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Authors and Affiliations

  1. Digestive Surgery and Transplantation Department, Claude Huriez Hospital, Lille University Medical Center, Lille, France

    Philippe Zerbib, Mohamad Seblini & François René Pruvot

  2. Vascular and General Surgery Department, Claude Huriez Hospital, Lille University Medical Center, Lille, France

    Céline Perot & Jean Pierre Chambon

  3. Department of Internal Medicine, Claude Huriez Hospital, Lille University Medical Center, Lille, France

    Marc Lambert

  4. Service de Chirurgie Digestive et Transplantation, Hôpital Claude Huriez, CHRU de Lille, 59037, Lille, France

    Philippe Zerbib

Authors
  1. Philippe Zerbib
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  2. Céline Perot
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  3. Marc Lambert
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  4. Mohamad Seblini
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  5. François René Pruvot
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  6. Jean Pierre Chambon
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Correspondence to Philippe Zerbib.

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Zerbib, P., Perot, C., Lambert, M. et al. Management of isolated spontaneous dissection of superior mesenteric artery. Langenbecks Arch Surg 395, 437–443 (2010). https://doi.org/10.1007/s00423-009-0537-1

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  • DOI: https://doi.org/10.1007/s00423-009-0537-1

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