phenprocoumon and Aortic-Dissection

A case of spontaneous, non-atherosclerotic dissection of the superior mesenteric artery is described. The patient presented with severe abdominal pain. An initial computed tomography scan did not disclose any pathology, namely the major mesenteric arteries were perfused. The patient's initial symptoms resolved during the first 48 h under conservative treatment. Sagittal reconstruction from a follow-up computed tomography scan disclosed a 7 cm long dissection of the proximal superior mesenteric artery with thrombosis of the false lumen and residual blood flow through the true lumen. There were no signs of transmural infarction of the bowel. Anticoagulation with heparin and later with phenprocoumon was initiated and the patient is well after 6 months. Together with several other cases reported recently, and in contrast to previous experience, this case adds evidence that conservative treatment of spontaneous, non-atherosclerotic dissection of the superior mesenteric artery may be an alternative to surgery if residual blood flow is maintained.

Topics: Anticoagulants; Aortic Dissection; Heparin; Humans; Male; Mesenteric Artery, Superior; Middle Aged; Phenprocoumon; Tomography, X-Ray Computed