Abstract
Background
Spontaneous visceral artery dissection (VAD) is a rare disease that mainly occurs
in the superior mesenteric artery and celiac artery. However, VAD has been detected
more frequently in the past several years because of the increasing use of computed
tomography (CT) for the evaluation of abdominal symptoms. A prompt diagnosis and referral
to a specialist should be made, because VAD occasionally causes critical bowel ischemia.
However, there is no well-established management approach. We performed a retrospective
analysis to evaluate the characteristics and prognoses of patients diagnosed with
VAD.
Methods
We retrospectively examined data on patients who visited the Emergency Department
(ED) at Fukui Prefectural Hospital, and were diagnosed with VAD using enhanced CT
scanning from April 2004 to March 2015. All data were collected from the hospital's
electronic medical records. We analyzed the clinical characteristics, comorbidity,
risk factors, imaging findings, and treatment of patients.
Results
Fifty-six patients were identified (superior mesenteric artery: 40 patients, celiac
artery: 16 patients). The median age of the patients was 54 years (range, 32-86 years)
and 89.3% were men. The majority of the patients complained of abdominal pain (37
patients, 66%). Thirty-nine of the patients (69.6%) were hospitalized. All hospitalized
patients received conservative treatment initially. Three patients received endovascular
therapy, and 2 patients received surgery. No fatal cases were observed. Twenty-eight
patients presented with ED at their initial visit, and 8 cases (29%) were undiagnosed
on their initial visit by emergency physicians, though enhanced CT scans were obtained.
Conclusion
Patients with VAD often present with sudden onset abdominal pain. Most patients were
managed successfully with conservative treatment. No fatal cases were observed; however,
some cases were missed, even with an enhanced CT scan. It is necessary to include
VAD among the differential diagnoses of acute abdominal pain. Patients with VAD should
be referred to a specialist, because this disease occasionally causes critical bowel
ischemia, necessitating surgical intervention.
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Article Info
Publication History
Published online: March 02, 2016
Accepted:
February 29,
2016
Received in revised form:
February 29,
2016
Received:
January 10,
2016
Footnotes
â?†Source of Support: None.
��Name of organization and date of assembly: 2015 European Congress on Emergency Medicine (ECEM), 10-14 October 2015.
Identification
Copyright
© 2016 Elsevier Inc. All rights reserved.
