Case Report of Isolated Superior Mesenteric Artery Dissection Following Thermal Shock

Abstract

Isolated superior mesenteric artery dissection is a rare vascular condition, although it is increasingly being identified due to the widespread use of computed tomography. It is associated with multiple conditions (atherosclerosis, vasculitis, segmental arterial mediolysis, fibromuscular dysplasia, connective tissue diseases, and middle arcuate ligament syndrome) and anatomical variants that increase the susceptibility of the arterial wall. Clinical presentation is variable, ranging from severe abdominal pain to an incidental finding. Management is usually conservative, and only a minority of cases require interventional treatment. The aim of this article was to present a case of isolated superior mesenteric artery dissection following thermal shock. The patient was a 62-year-old man who presented with sudden, severe epigastric pain following multiple alternating immersions in very cold (-3 °C) and hot (37 °C) water. He was admitted in hemodynamically stable condition and underwent a contrast-enhanced CT scan, which revealed a spontaneous dissection of the superior mesenteric artery (Sakamoto IIa) without ischemia. Medical management was initiated, and the patient’s condition improved. In this case, the temporal relationship between cryotherapy and the isolated superior mesenteric artery dissection suggests that thermal shock may have precipitated it, although causality has not been demonstrated. Biological plausibility, reports of other vascular events following cryotherapy, and the association of low temperatures with aortic events support the need for increased vigilance, better patient selection, and consideration of this etiology in cases of sudden post-cryotherapy abdominal pain. It is concluded that isolated superior mesenteric artery dissection is a rare cause of acute abdominal pain, and in this case, the temporal proximity to thermal shock suggests a possible triggering role of cold, although causality has not been demonstrated. Together with previous reports of vascular events following cryotherapy, this highlights the need for increased clinical vigilance and further studies on its cardiovascular safety.