Type 3 intestinal failure after bypass grafting for isolated acute superior mesenteric artery dissection: A case report

Isolated superior mesenteric artery (SMA) dissection is a very rare cause of mesenteric ischemia. A 66-year-old male patient was admitted to our emergency department with severe epigastric pain. He was diagnosed with spontaneous SMA dissection leading to intestinal ischemia. A bypass graft was used to relieve acute ischemia with an initial success. However, this success was not sustained, as the graft failed slowly despite a satisfactory technical appearance, leading to type 3 intestinal failure which could be explained by the competitive flow. In conclusion, bypass grafting may yield short-term bowel viability in the treatment of isolated SMA dissection and acute ischemia; however, grafts may fail without radiologically apparent technical complications possibly due to the competitive flow from the collateralizing circuits.