Dissection of the superior mesenteric artery:a rare cause of abdominal pain

HISTORY: A previously healthy 47-year-oldman had suffered from intermittent subacute abdominal pain for sixweeks. He had no significant past medical history except of smoking(30 pack years). INVESTIGATIONS: Physical examinationand laboratory tests were unremarkable. Sonography and endoscopyshowed no pathological findings. Eventually contrast-enhanced computedtomography revealed dissection of the superior mesenteric artery andan additional angiography showed a false aneurysm. TREATMENT AND COURSE: Because of theextended dissection thrombarterectomy was preferred to percutaneousstent placement. Five months later the patient was free of symptomsand continues to take 100 mg aspirin daily. CONCLUSIONS: Although spontaneous visceralartery dissection is uncommon, awareness of this event is crucialfor diagnosis and therapy to prevent hemorrhage and potential bowelinfarction. This case highlights the importance of computed tomographyin the work-up of nonspecific abdominal pain.