SPONTANEOUS SMA DISSECTION: AN UNUSUAL CAUSE OF INTESTINAL OBSTRUCTION

1. SPONTANEOUS SMA DISSECTION: AN UNUSUAL
CAUSE OF INTESTINAL OBSTRUCTION
Dr Saumitra Barthwal, Dr Narinder Kaur.
Department of Radiodiagnosis,
Government Medical College & Hospital, Chandigarh.

2. INTRODUCTION
• 67-year-old male presented to the surgery emergency with c/o non passage
of stool since 3 days and severe pain abdomen localized to the epigastric
and periumbilical region.
• Known case of type II diabetes mellitus on medications.
• On examination his abdomen was tender, distended, with absent bowel
sounds.
• On erect abdominal x-ray, dilated small bowel loops with few air fluid
levels were seen which necessitated an emergency contrast enhanced CT
(CECT) abdomen.

3. CT scanogram shows multiple dilated
jejunal loops. Multiple air foci are seen
lining the periphery of bowel lumen
suspicious for pneumatosis intestinalis.

4. A. Axial non contrast CT abdomen shows dilated jejunal loops with internal air-fluid levels and
multiple intramural air foci s/o pneumatosis intestinalis.
B. Axial contrast enhanced CT abdomen image show multiple air foci within the small bowel
mesentery (long green arrow).
C. Axial contrast enhanced CT abdomen images show air foci within the liver parenchyma reaching
upto its periphery suggestive of portal vein gas (small green arrows).
A. B C

5. A B C
A & B: Sagittal reformatted and axial CECT abdomen image shows a linear hypodense intimal
flap within the lumen of SMA suggestive of SMA dissection.
C: Coronal reformatted CECT abdomen shows non opacification of the jejunal branches of SMA
consistent with thrombosis.

6. DIAGNOSIS AND FOLLOW UP
• Diagnosis: Mesenteric ischemia secondary to SMA dissection and
thrombosis.
• Follow up: Patient underwent resection of gangrenous gut following
which he succumbed before any vascular intervention could be
attempted.