Presentation
Abdominal pain without radiation after drinking 6 beers.
Patient Data
The superior mesenteric artery dissection is identified, with non-occlusive filling defect. Large segments of jejunum demonstrate hypo-enhancement of the wall.
CT angiogram 10 days later
A superior mesenteric artery dissection with focal areas of proximal complete occlusion in the superior mesenteric artery and proximal jejunal branches is identified. Distal superior mesenteric artery territory is perfused.
There is fusiform aneurysmal dilatation of the bilateral common iliac arteries measuring up to 2.2 cm, concerning for an underlying vascular pathology.
There is a beaded appearance of the main right renal artery also concerning for an underlying vascular pathology.
Case Discussion
Spontaneous isolated superior mesenteric artery dissection (SISMAD) is an uncommon cause of acute abdomen that is rarely considered in the differential for abdominal pain. The location of the pain may vary depending on the location of the dissection and the extent of bowel ischaemia. Up until 2009 there were only 106 cases of SISMADs in the literature. The suspected aetiology of SISMADs include cystic medial degeneration of arterial wall, hypertension, atherosclerosis or other vasculopathies such as fibromuscular dysplasia, Ehlers-Danlos, and Marfan disease. While the cause of SISMAD is usually not identified, it is important to rule out any intrinsic diseases such as fibromuscular dysplasia or other genetic causes.
Case contributed by: Kamil Abu-Shaban and Xiaochen Liu.