Introduction

Isolated superior mesenteric artery dissection (ISMAD) is an uncommon but important vascular cause of acute abdominal pain. It is defined as dissection confined to the superior mesenteric artery without concomitant aortic dissection. The superior mesenteric artery supplies a substantial portion of the small intestine and proximal colon. In ISMAD, blood entering through an intimal tear creates a false lumen that may compress the true lumen and impair mesenteric perfusion, potentially resulting in bowel ischemia or, rarely, arterial rupture [1,2]. Clinical manifestations vary from incidental detection or mild abdominal discomfort to severe pain and intestinal ischemia; therefore, diagnosis depends heavily on contrast-enhanced computed tomography (CT). Reported cases predominantly involve middle-aged men, and commonly described risk factors include hypertension, smoking, and other vascular risk factors [1-3].

The optimal management of ISMAD remains individualized. Conservative treatment is commonly selected for hemodynamically stable patients when there is no evidence of bowel ischemia, arterial rupture, or progressive vascular compromise. In contrast, endovascular or surgical intervention may be required when persistent or worsening symptoms, intestinal ischemia, arterial rupture, aneurysmal dilatation, or compromised distal perfusion is present [1,4-6]. Thus, the initial imaging assessment should not only establish the diagnosis but also stratify the risk of complications.

ISMAD during the postpartum period is extremely rare. This setting is diagnostically challenging because abdominal pain after cesarean delivery is more commonly attributed to postoperative pain, ileus, infection, uterine involution, intra-abdominal bleeding, or other obstetric and surgical complications. Only one case of ISMAD after childbirth has been reported previously [7].

We report, to our knowledge, the first case of ISMAD after cesarean delivery. The case emphasizes the need to consider visceral arterial dissection when postpartum abdominal pain is atypical, severe, persistent, or disproportionate to the expected postoperative course.