Spontaneous superior mesenteric artery (SMA) dissections are rare events. We report successful jejunal artery reconstruction using the right gastroepiploic artery in a patient with spontaneous SMA dissection and severe postprandial mesenteric angina. A 42-year-old man seen for severe postprandial abdominal pain and diagnosed with mesenteric angina due to spontaneous SMA dissection was found in computed tomography to have dissected SMA 3cm distal from its origin, necessitating emergency surgery to avoid necrotic change in the small intestine if at all possible due to its high mortality. Laparotomy showed the small intestine to not be necrotic but had a dark color due to poor blood flow. The dissection extended into the origin of the small branches to the jejunum, ileum, ascending colon, and transverse colon, suggesting potential necrosis, if dissection progressed. Although restoration of blood flow to the small intestine was recommended, it was not possible to reconstruct all small SMA branches, so the fourth jejunal artery was reconstructed using the right gastroepiploic artery to avoid total necrosis of the small intestine. The whole intestinal blood flow was restored via the marginal artery as a result of this reconstruction. The man was treated for postoperative anticoagulation using heparin followed by warfarin. The postoperative course was uneventful and postprandial abdominal pain completely disappeared.
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