A residual intimal flap could be identified in the first case, whereas the second case only showed a complete thrombosis of the lumen in the absence of any additional radiological signs. Therefore, the second case outlines that one should also consider IDSMA as a diagnosis, even though clinical and radiological signs led to the conclusion of an acute Selleck Dibutyryl-cAMP embolism as a working diagnosis. We performed a colonoscopy to exclude an ischemic lesion in both cases within the first week following operative treatment. We believe that endoscopic endoluminal control of the intestinal
mucosa provides additional patient security. We suggest considering this approach to be standardized in the postoperative therapy of patients with IDSMA, even if patients present LY2874455 purchase as asymptomatic. Both patients received effective anticoagulation during direct postoperative therapy. In due course, this was changed to antiplatelet drugs. We intend to continue this medication for at least six months, after which the patients will be seen in our outpatient department and will undergo a follow-up CT scan. This regime has been described in a retrospective analysis by Li et al. and we consider it to be reasonable [17]. Conclusion IDSMA remains a severe disease. Current therapeutic
options suggest conservative management in asymptomatic patients, despite knowing that a failure rate of over 30% has been evidenced in such an approach [17, 32]. Endovascular therapy should be the first therapeutic choice, as a hospital stay is shorter and mortality rate is lower compared to open surgery. Indications for open surgery are suspected bowel infarction or a rupture of the SMA [17]. NVP-BGJ398 In this paper, we presented two further cases where open surgery was performed. An anatomical variant and the suspicion of an acute embolism with bowel infarction made open surgery necessary. References 1. Sartelet H, Fedaoui-Delalou D, Capovilla M, Marmonier MJ, Pinteaux A, Lallement PY: Fatal hemorrhage due to an isolated dissection of the superior mesenteric artery. Intensive Care Med
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