Dissektion der Arteria mesenterica superior als Ursache abdomineller Schmerzen

Zusammenfassung

Anamnese: Ein 47-jähriger zuvor gesunder Patient präsentierte sich mit seit 6 Wochen bestehenden intermittierenden krampfartigen Bauchschmerzen ohne wesentliche Vorerkrankungen. Es bestand ein Nikotinabusus von ca. 30 Packungsjahren.

Untersuchungsbefunde: Körperliche Untersuchung, Labor, Sonografie und Endoskopie ergaben keinen wegweisenden pathologischen Befund, erst die abdominelle Computertomografie erbrachte den Nachweis eines isolierten Aneurysma dissecans der Arteria mesenterica superior mit Wandhämatom sowie einer Darmwandverdickung möglicherweise durch passagere Ischämie.

Therapie und Verlauf: Die operative Therapie bestand in einer Thrombendarteriektomie; der Patient ist 5 Monate später weiterhin beschwerdefrei.

Folgerung: Bei Patienten mit unklaren Bauchschmerzen sollte auch ohne Hinweise auf eine Arteriosklerose oder andere Gefäßerkrankungen an die seltene Möglichkeit der spontanen Dissektion von Viszeralarterien gedacht werden. Der Fall unterstreicht die Bedeutung der Computertomographie bei der Abklärung abdomineller Beschwerden.

Summary

History: A previously healthy 47-year-old man had suffered from intermittent subacute abdominal pain for six weeks. He had no significant past medical history except of smoking (30 pack years).

Investigations: Physical examination and laboratory tests were unremarkable. Sonography and endoscopy showed no pathological findings. Eventually contrast-enhanced computed tomography revealed dissection of the superior mesenteric artery and an additional angiography showed a false aneurysm.

Treatment and course: Because of the extended dissection thrombarterectomy was preferred to percutaneous stent placement. Five months later the patient was free of symptoms and continues to take 100 mg aspirin daily.

Conclusions: Although spontaneous visceral artery dissection is uncommon, awareness of this event is crucial for diagnosis and therapy to prevent hemorrhage and potential bowel infarction. This case highlights the importance of computed tomography in the work-up of nonspecific abdominal pain.

Schlüsselwörter

Arteria mesenterica superior - Dissektion - Aneurysma - Computertomografie

Keywords

superior mesenteric artery - dissection - dissecting aneurysm - computed tomography

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