Nine cases of isolated dissection of visceral artery

Abstract

Background : We need to consider emergency diseases typified by vascular lesions in sudden severe epigastralgia or back pain. Isolated visceral artery dissection is rare, but it is necessary to consider as the cause of sudden severe epigastralgia or back pain. Subjects & Methods : Between January 2010 and December 2012, nine cases diagnosed with dissection of isolated visceral artery were experienced in our hospital. We retrospectively examined their medical records to obtain patients’ data. Results : Four of the patients were men. The average age was 61±13 years. Six superior mesenteric artery, two celiac artery and one left gastric artery dissection were detected. As risk factors, there were four cases each of hypertension and smoking. All cases had sudden abdominal or back pain. Eight cases were diagnosed by contrasting CT (Com-puted Tomography), and one case by angiography. Four cases were diagnosed by radiologist, not emergency physician. D-dimer was elevated in 2 cases. No patients had organ ischemia, so all patients were well managed with conservative therapy. Conclusion : We need to consider isolated dissection of visceral artery as the cause of severe epigastralgia or back pain. CT is useful for diagnosis, but diagnosis is actually difficult. D-dimer is not useful in ruling out this disease. If intestinal ischemia is not detected, conservative management may provide a good course. (JJAAM. 2014; 25: 710-6)