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J Korean Soc Emerg Med > Volume 21(5); 2010 > Article
Journal of The Korean Society of Emergency Medicine 2010;21(5): 615-621.
Diagnosis of Spontaneous Isolated Superior Mesenteric Artery Dissection in the Emergency Department: A Case Series
Shin Ahn, Chang Hwan Sohn, Dong Woo Seo, Kyoung Soo Lim, Won Kim
Department of Emergency Medicine, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea. wkim09@gmail.com
Spontaneous isolated superior mesenteric artery (SMA) dissection is a rare disease. Many such patients are overlooked in the emergency department (ED), and are sent home with a diagnosis other than SMA dissection. In this study, we analyzed clinical findings for patients with isolated SMA dissections, and attempted to identify those ED patients for whom the diagnosis should be considered.
A retrospective observational case series of nineteen patients diagnosed with spontaneous isolated SMA dissection in the ED was done. Demographic data, information regarding pain, the nature and number of cardiovascular risk factors, and laboratory and physical examination findings were analyzed.
The median age at which SMA was diagnosed was 54 (44-71) years; 78.9% were male. The most common symptom was sudden onset of severe epigastric pain with cramping. Variations in location of pain included the periumbilical area (31.6%), and the whole abdomen and lower abdomen (10.5% each). Besides cramping (57.9%), dull ache (31.6%) and abdominal fullness (10.5%) were other symptoms. Pain radiation was not noticed in 13 (68.4%) subjects, but 3 complained of their pain radiating to their back. Direct tenderness was present in 9 (47.4%) patients and rebound tenderness in 3 (15.8%). In 10 (52.6%), there was no tenderness.
Physicians who assess patients with severe abdominal pain, especially men in their fifties, should generate a high index of suspicion regarding SMA dissection. Contrast enhanced CT scans should be performed in patients with sudden onset of severe epigastric pain, regardless of its nature, radiation, or associated symptoms, and especially whose abdominal physical examination was unremarkable.
Key words: Superior mesenteric artery, Dissection, Diagnosis, Emergency department
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