Spontaneous isolated superior mesenteric artery (SMA) dissection presenting with bowel infarction, widespread bowel ischemia, or SMA rupture constitutes a surgical emergency that mandates immediate operative intervention.

Clinical scenario

This protocol applies when SMA dissection is accompanied by bowel infarction or widespread bowel ischemia, or when SMA rupture has occurred. In these presentations, a surgical procedure is inevitable — surgical management is reserved for cases with infarction or widespread bowel ischemia and for cases where other treatment modalities have failed.

Approach (partial overview)

Management requires open surgical intervention that addresses both the compromised bowel and the arterial lesion. The specific operative steps and technique selection are determined by the extent of gut viability, the type of dissection, and the reversibility of circulation. The complete structured regimen — including the full sequence of interventional options — is available via the protocol.

References

A surgical procedure is inevitable in cases of bowel infarction or SMA rupture.
Surgical management should be reserved for cases having infarction or widespread bowel ischemia and in cases where other treatment modalities fail.
We found that about 28.9% (n=42/145) patients underwent surgical management and that bypass grafting was the commonest procedure.
The extent and type of surgery depends on the viability of gut, type of dissection and the reversibility of circulation.
These surgical interventions for SMA dissection had successful resolution of symptoms on their mean follow up of 15.8 months where the follow up ranged from 0.23 to 48 months.

DOI: 10.4070/kcj.2018.0429

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Spontaneous Isolated SMA Dissection Complicated by Bowel Infarction or Widespread Ischemia

References