Spontan İzole Superior Mezenterik Arter Diseksiyonu: Nadir Görülen Bir Olgu Sunumu

Öz

İzole superior mezenterik arter diseksiyonu (İSMAD), sadece superior mezenterik arterde spontan gelişen nadir bir vasküler hastalıktır. Genellikle asemptomatik olan bu hastalık, çoğunlukla başka nedenlerle çekilen görüntülemelerde tesadüfen saptanır. Semptomatik hastalarda en sık görülen belirti ani başlayan karın ağrısıdır. Ancak hastalığa özgü olmayan bu semptomlar nedeniyle tanı gecikebilir ve ciddi komplikasyonlar gelişebilir.Bu olgu sunumunda, 50 yaşında, yandaş hastalığı olmayan bir erkek hasta, üç gündür şiddetlenen karın ağrısı ve bulantı şikâyeti ile başvurmuştur. Yapılan bilgisayarlı tomografi ile SMA’nın proksimal-orta segmentinde yaklaşık 4 cm uzunluğunda intimal flep ve jejunal dal oklüzyonu saptanmış, Sakamoto Tip IV diseksiyon tanısı konmuştur. Hemodinamik olarak stabil olan hastada cerrahi ya da endovasküler müdahale gerekmemiş, konservatif tedavi uygulanmıştır. Antiplatelet tedavi başlanmış ve hastanın semptomları düzelmiştir. Klinik ve radyolojik takipte herhangi bir şikâyet tekrarı gözlenmemiştir. İSMAD tedavisinde hastanın klinik durumu ve diseksiyon tipi göz önüne alınarak konservatif tedavi, cerrahi ve endovasküler tedavi seçenekleri arasında karar verilir. Tip IV diseksiyon ve intestinal skemi bulgusu olmayan semptomatik hastalarda konservatif tedavi etkili ve güvenli olabilir. Ancak düzenli takip şarttır. Bu olgu, hasta bazlı yaklaşımın ve yakın klinik-radyolojik izlemin önemini vurgulamaktadır.

Anahtar Kelimeler

• Superior mezenterik arter diseksiyonu
• mezenterik iskemi
• konservatif tedavi
• Sakamoto sınıflaması

Spontaneous Isolated Superior Mesenteric Artery Dissection: A Rare Case Report

Öz

Isolated superior mesenteric artery dissection (ISMAD) is a rare vascular disease occurring spontaneously in the superior mesenteric artery alone. It is often asymptomatic and usually detected incidentally during imaging performed for other reasons. The most common symptom in symptomatic patients is sudden onset abdominal pain. However, due to the nonspecific nature of symptoms, diagnosis may be delayed, leading to serious complications. In this case report, a 50-year-old male patient without comorbidities presented with worsening abdominal pain and nausea lasting three days. Abdominal computed tomography revealed an approximately 4 cm intimal flap and jejunal branch occlusion in the proximal-mid segment of the SMA, consistent with Sakamoto Type IV dissection. The patient was hemodynamically stable and did not require surgical or endovascular intervention; conservative management was chosen. Antiplatelet therapy was initiated, leading to symptom resolution. No symptom recurrence was observed during clinical and radiological follow-up. Treatment of ISMAD depends on clinical status and dissection type, including conservative, surgical, and endovascular approaches. Conservative treatment can be effective and safe in symptomatic patients with Type IV dissection and no signs of intestinal ischemia. However, regular follow-up is essential. This case highlights the importance of individualized patient management and close clinical-radiological monitoring.

Anahtar Kelimeler

• Superior mesenteric artery dissection
• mesenteric ischemia
• conservative treatment
• Sakamoto classification

Kaynakça

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