Spontaneous Isolated Superior Mesenteric Artery Dissection Presenting as Paralytic Ileus: A Case Report

Spontaneous isolated superior mesenteric artery dissection (SISMAD) is an uncommon vascular disorder that usually presents with acute abdominal pain but may mimic other abdominal emergencies.We report a 56-year-old man who presented with a three-day history of progressive abdominal distension, abdominal pain, vomiting, and constipation.He was hemodynamically stable, and plain abdominal radiography showed dilated bowel loops with air-fluid levels suggestive of paralytic ileus.Contrast-enhanced computed tomography (CECT) and computed tomography angiography (CTA) demonstrated an isolated superior mesenteric artery (SMA) dissection without any evidence of ischemia or mechanical obstruction.The patient was managed conservatively with bowel rest, analgesics, and antiplatelet therapy, with complete clinical improvement.This case highlights that SISMAD can present with an ileus-like, pseudo-obstructive clinical picture.CTA is central to confirming the vascular diagnosis and assessing bowel viability.In hemodynamically stable patients without evidence of bowel ischemia, initial conservative management with close clinical surveillance is an appropriate treatment strategy.