CARDIOVASCULAR JOURNAL OF AFRICA • Volume 34, No 5, November/December 2023 320 AFRICA related to intestinal ischaemia and hypomotility. Based on previous studies, inadequate splanchnic blood flow and ensuing local hypoxia result in microvascular injury, production of cytotoxic molecules, and cellular necrosis or apoptosis. Several intestinal cell types are vulnerable to damage during ischaemia– reperfusion injury, including epithelial cells and neurons and glial cells, which are part of the enteric nervous system (ENS). The ENS regulates intestinal motility, co-ordinates secretion, and contributes to gut immune function. Permanent damage to the ENS, through a variety of mechanisms, can result in longterm intestinal dysfunction.10,11 We performed a second-look laparoscopy and removed the abnormal intestine.12 The patient had a complete remission of symptoms postoperatively. After one year of follow up, the patient’s abdominal symptoms had not recurred and CTA showed good results (Fig. 4). Conclusion Untreated superior mesenteric arterial dissection is related to high morbidity and mortality rates caused by progressive ischaemia of the bowel or aneurysm rupture.13 Among the variety of risk factors, condition of the branches is a very important factor affecting intestinal ischaemia. An invasive treatment approach was considered in patients with thrombosis of branches who developed increasingly severe pain after anticoagulant treatment.14 Endovascular stenting and laparoscopy are important minimally invasive treatments. References 1. Bauersfeld SR. Dissecting aneurysm of the aorta: a presentation of fifteen cases and a review of the recent literature. Ann Intern Med 1947; 26: 873–879. 2. Patelis N, Doukas P, Dodos I, et al. endovascular repair of a complex isolated dissecting aneurysm of the superior mesenteric artery. Eur J Vasc Endovasc Surg Short Rep 2019; 44: 5–8. 3. Salt Ö, Sayhan MB, Duyar E. Isolated superior mesenteric artery dissection in the emergency department: A rare cause of abdominal pain. Am J Emerg Med 2018; 36(12): 2341.e1–2341.e2. 4. Luan JY, Li X. Computed tomography imaging features and classification of isolated dissection of the superior mesenteric artery. Eur J Vasc Endovasc Surg 2013; 46(2): 232–235. 5. Qiu CY, He YY, Li DL, et al. Mid-term results of endovascular treatment for spontaneous isolated dissection of the superior mesenteric artery. Eur J Vasc Endovasc Surg 2019: 58(1): 88–95. 6. Tanaka Y, Yoshimuta T, Kimura K, et al. Clinical characteristics of spontaneous isolated visceral artery dissection. J Vasc Surg 2018; 67(4): 1127–1133. 7. Dong Z, Fu W, Chen B, et al. Treatment of symptomatic isolated dissection of superior mesenteric artery. J Vasc Surg 2013; 57(2 Suppl): 69S–76S. 8. Sidawy AN, Perler BA. Rutherford’s Vascular Surgery and Endovascular Therapy. 9th edn. Philadelphia, PA: Elsevier, 2019. 9. Okazaki M, Higashihara H, Ono H, et al. Chemoembolization for hepatocellular carcinoma via the inferior pancreaticoduodenal artery in patients with celiac artery stenosis. Acta Radiol 1993; 34(1): 20–25. 10. Rubin DC, Levin MS. Mechanisms of intestinal adaptation. Best Pract Res Clin Gastroenterol 2016; 30(2): 237–248. 11. Langness S, Coimbra R, Eliceiri BP, et al. Vagus nerve mediates the neural stem cell response to intestinal injury. J Am Coll Surg 2015; 221(4): 871–879. 12. Meng X, Liu L, Jiang H. Indications and procedures for second-look surgery in acute mesenteric ischemia. Surg Today 2010; 40(8): 700–705. 13. Jeong MJ, Kwon H, Kim A, et al. Clinical outcomes of conservative treatment in patients with symptomatic isolated spontaneous renal artery dissection and comparison with superior mesenteric artery dissection. Eur J Vasc Endovasc Surg 2018; 56(2): 291–297. 14. Kim H, Park H, Park SJ, et al. Outcomes of spontaneous isolated superior mesenteric artery dissection without antithrombotic use. Eur J Vasc Endovasc Surg 2018; 55(1): 132–137. Fig. 4. Postoperative CT scan shows patent Riolan arch (white arrow).
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