Preprint Case Report Version 1 Preserved in Portico This version is not peer-reviewed

Isolated Intramural Hematoma of Superior Mesenteric Artery: Case Reports and a Review of Literature

Marta Ascione
* ORCID logo ,
Rocco Cangiano
ORCID logo ,
Alireza Mohseni
ORCID logo ,
Andrea Molinari
,
Antonio Marzano
,
Alessia Di Girolamo
,
Luca Di Marzo
,
Wassim Mansour
*
Version 1 : Received: 4 November 2023 / Approved: 6 November 2023 / Online: 6 November 2023 (13:42:55 CET)

A peer-reviewed article of this Preprint also exists.

Ascione, M.; Cangiano, R.; Mohseni, A.; Molinari, A.; Marzano, A.; Di Girolamo, A.; Di Marzo, L.; Mansour, W. Isolated Intramural Hematoma of Superior Mesenteric Artery: Case Reports and a Review of Literature. Diagnostics 2023, 13, 3581. Ascione, M.; Cangiano, R.; Mohseni, A.; Molinari, A.; Marzano, A.; Di Girolamo, A.; Di Marzo, L.; Mansour, W. Isolated Intramural Hematoma of Superior Mesenteric Artery: Case Reports and a Review of Literature. Diagnostics 2023, 13, 3581.

Abstract

(1) Background: Spontaneous isolated intramural hematoma of the superior mesenteric artery (SIHSMA) is a rare entity often considered as a subset of spontaneous isolated dissection of the superior mesenteric artery (SIDSMA). It is characterized by a completely thrombosed false lumen with or without ulcer-like projection with computed tomography (CT) imaging. The recent literature describes few reports with a relatively short-term follow-up. The natural course, prognosis, and treatment options for SIHSMA still lack consensus. We present two cases of acute abdominal pain in a young man due to IMH of the superior mesenteric artery with an extensive literature review. (2) Case report: A 46-year-old male patient was submitted to an urgent CTA for acute abdominal pain, showing the presence of an isolated dissection of the superior mesenteric artery, determining significant stenosis of the vessel with collateral vessel patency. The patient referred to a recent COVID-19 infection, whose course was paucisymptomatic. He was treated conservatively with antiplatelet therapy and corticosteroid treatments, and, after a few days, the symptomatology completely regressed; also, 2-month- control CTA showed the complete IMH regression and the absence of any signs of residual stenosis. The second patient is a 61-year-old male patient who was submitted to an urgent CTA for acute abdominal pain, showing the presence of an isolated dissection of the superior mesenteric artery, not determining significant vessel stenosis. He was treated conservatively with antiplatelet therapy and corticosteroid treatment, and after a few days, the symptomatology completely regressed, and the radiological control showed a complete dissection regression. (3) Conclusion: SISHSMA is a rare entity of vascular pathology, and conservative management represents the best medical strategy. We propose corticosteroid treatment as one of the most appropriate tools in the conservative treatment of SISHSMA.

Keywords

intramural hematoma; superior mesenteric artery; treatment; steroid

Subject

Medicine and Pharmacology, Other

Copyright: This is an open access article distributed under the Creative Commons Attribution License which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

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