An isolated superior mesenteric artery (SMA) dissection (ISMAD) is extremely rare among visceral artery dissections. Its diagnosis is made by abdominal contrast CT scan which shows SMA occlusion partially or completely. The ISMAD is classified into 6 types: type I–V has partial occlusion and treated medically using antiplatelets or anticoagulants. On the other hand, type VI has complete occlusion and must be treated by urgent surgical operation. We present a 67-year-old female who presented with sudden onset abdominal pain and melena. An urgent contrast CT revealed type VI ISMAD. She underwent 3 staged operations as follows: (1) first, as laparotomy showed pale color in almost the extensive length of the small intestine, arterial bypassing of SMA was undertaken using SMA to the right common iliac artery bypass; (2) as the second-look operation on the next day, the terminal ileum was resected, and the remaining small intestine was able to be preserved. However, when the abdomen was tried to be closed, systemic blood pressure decreased to pre-shock condition, so the abdominal wall was closed at skin level with silastic sheet. (3) As the third-look operation on the 7th day, ileostomy was created, and the abdominal wall was safely closed. The postoperative course was uneventful. This case study shows that SMA grafting and staged operations might be an option to preserve the length of the small intestine when ISMAD is diagnosed as type VI.
Case Rep Gastroenterol 2021;15:715–719

中文翻译：

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分期手术作为 VI 型孤立性肠系膜上动脉夹层患者的手术策略

孤立的肠系膜上动脉 (SMA) 夹层 (ISMAD) 在内脏动脉夹层中极为罕见。其诊断是通过腹部对比 CT 扫描显示部分或完全 SMA 闭塞。ISMAD 分为 6 种类型：I-V 型部分闭塞，药物治疗使用抗血小板或抗凝剂。另一方面，VI型完全闭塞，必须紧急手术治疗。我们介绍了一位 67 岁的女性，她突然出现腹痛和黑便。紧急对比 CT 显示 VI 型 ISMAD。她经历了如下3个阶段的手术​​：（1）首先，由于剖腹手术在几乎广泛的小肠长度上显示出苍白的颜色，因此使用SMA进行了SMA的动脉旁路到右侧髂总动脉旁路；(2)次日复诊，切除末端回肠，保留剩余小肠。然而，当试图关闭腹部时，全身血压下降到休克前的状态，因此用硅橡胶片在皮肤水平关闭腹壁。(3)第7天第三眼手术，开回肠造口，安全闭合腹壁。术后过程很顺利。该案例研究表明，当 ISMAD 被诊断为 VI 型时，SMA 移植和分期手术可能是保留小肠长度的一种选择。所以用硅橡胶片在皮肤水平关闭腹壁。(3)第7天第三眼手术，开回肠造口，安全闭合腹壁。术后过程很顺利。该案例研究表明，当 ISMAD 被诊断为 VI 型时，SMA 移植和分期手术可能是保留小肠长度的一种选择。所以用硅橡胶片在皮肤水平关闭腹壁。(3)第7天第三眼手术，开回肠造口，安全闭合腹壁。术后过程很顺利。该案例研究表明，当 ISMAD 被诊断为 VI 型时，SMA 移植和分期手术可能是保留小肠长度的一种选择。
Case Rep Gastroenterol 2021；15:715–719