Our findings were not consistent with the hypothesis of Solis et al., but we suppose that the dissection plane can

extend not only distally but also proximally. The natural history of the disease is also unclear and depends on each case. Most patients present with acute epigastric pain, which is considered to be caused by the dissection itself or intestinal ischemia. Other common symptoms are nausea, vomiting, melena, and abdominal distention. These patients present acutely with symptom duration of <4 weeks [22]. Laboratory selleck inhibitor tests and abdominal radiography are usually unremarkable. Therefore, we often initially presume that the patient has enterocolitis and gastritis. Sometimes, laboratory tests show slightly elevated serum amylase, such as in our case 1, which might be caused by occlusion of the duodeno-pancreatic arcade [10]. Diagnosis in the acute stage has become possible as a result of advances and increased use of imaging techniques such as MDCT, leading to MPR and reconstruction imaging, and CTA [1–4]. Dynamic enhanced CT shows that the separated true lumen and false lumen can be identified by the presence of an intimal flap. Plain CT shows areas of high intensity if there is an acute clot in the false lumen. Sakamoto et al. [23] have categorized SMA dissection into four types based check details on contrast-enhanced CT scanning. Recently, Yun et al. [24] have added total thrombotic

occlusion of the SMA trunk to Sakamoto’s classification, and have devised a new classification of three types based on angiographic findings: type I: patent true and false lumina that show entry and re-entry sites; type II: patent true lumen but no re-entry flow from the false lumen; type IIa: visible false lumen but no visible re-entry site (blind pouch of false lumen); type IIb: no visible false luminal flow (thrombosed false lumen), which usually causes true luminal narrowing; and type III: SMA dissection with occlusion of SMA. However, neither Sakamoto et al. nor Yun et al. have

found a clear relationship between radiological appearance and clinical course. Abdominal color Doppler echo is also effective for following hemodynamic changes within the SMA, bowel movement, MRIP and signs of bowel ischemia, such as wall thickening and intestinal dilatation. Some treatment algorithms for management of spontaneous SMA dissection have been reported [22, 25, 26]. At present, however, there is no established opinion on the indications for surgical revascularization, conservative medical management, or endovascular therapy. Some cases have been successfully treated by conservative therapy, such as anticoagulation [5, 6]. Karacagi et al have reported that immediate anticoagulation therapy achieved prevention of clot formation in the true lumen in patients with spontaneous dissection of the carotid artery[27].