Korean J Med > Volume 79(2); 2010 > Article
위창자간막동맥의 단독 벽내 혈종
A 46-year-old man was admitted to our hospital because of abrupt-onset epigastric and back pain, which was aggravated following meals. He avidly exercised strenuously, including running marathons and weight lifting. The physical examination was unremarkable except for mild direct tenderness in the epigastric area. Ultrasonography of the upper and lower abdomen was normal esophagogastroduodenoscopy showed minimal reflux esophagitis, and his pain was not relieved by a number of medications. Computed tomography angiography (CTA) revealed an intramural hematoma without dissection obstructing the true lumen of the proximal to middle portion of the superior mesenteric artery (SMA) (Fig. 1, arrows). Low-molecular-weight heparin was administered, followed by warfarin, and the patient improved after 1 week of treatment. Follow-up CTA at 4 months indicated complete resorption of the intramural hematoma and restoration of the true lumen of the SMA (Fig. 2, arrows). One year later, the patient remains asymptomatic without further treatment. There are rare reports of isolated dissection of the SMA, especially in Asian populations. The causes are unknown and the treatment options vary, and include surgery, endovascular treatment, or conservative management dependent on the extent of dissection and the associated complications1-3).

REFERENCES

1. Furukawa D, Dowaki S, Izumi H, Okamoto Y, Imaizumi T, Makuuchi H. Isolated spontaneous dissection of the superior mesenteric artery in two cases treated with conservative therapy. Nippon Shokakibyo Gakkai Zasshi 106:1031–1038, 2009.
pmid

2. Kwak JW, Paik CN, Lee KM, Chung WC, Jung SH, Kim JE, Baik JH, Yang JM. Isolated spontaneous dissection of superior mesenteric artery: treated by percutaneous endovascular stent placement. Korean J Gastroenterol 55:58–61, 2010.
crossref pmid

3. Sung JH, Kim TY, Jeong H, Lee J, Park JH, Phyun LH, Kim IJ, Cho YK, Lim SW, Cha DH, Lim CY. A case of aortic dissenction with compromised superior mesenteric artery treated with stents insertion at origin of the artery. Korean Circ J 32:911–916, 2002.


Computed tomography angiography shows an intramural hematoma without dissection obstructing the true lumen of the proximal to middle portion of the superior mesenteric artery (arrows).
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Figure 1.
Computed tomography angiography after 4 months shows complete resorption of the intramural hematoma and restoration of the true lumen of the superior mesenteric artery (arrows).
/upload/thumbnails/kjm-79-2-138-7f2.gif
Figure 2.
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