A Case of Isolated Celiac Axis Injury by Blunt Abdominal Trauma

Abstract

A lthough blunt abdominal trauma is common, injury to the celiac axis (CA) is a rare occurrence, but with significant mortality. This report describes and discusses the presentation and management of one patient with an isolated CA injury in context with the literature. CASE REPORTA 39-year-old, previously healthy, man with no history of trauma was transferred from a referring institution after suffering direct compression from the tailgate of a cargo truck. On presentation to the emergency department, the patient complained of severe epigastric pain but no superficial injury was observed. A physical examination revealed a heart rate of 70 beats per minute, a systolic blood pressure of 92 mm Hg, severe epigastric tenderness with muscle guarding and an absence of bowel sounds. Laboratory findings on admission revealed an elevated white blood cell count of 24.2 ϫ 10 3 L aspartate aminotransferase of 347 lU/L, alanine aminotransferase of 347 IU/L, and lactate dehydrogenase of 1035 IU/L. There was no anemia or elevation of serum amylase level observed.Computed tomography revealed a large midline retroperitoneal hematoma in the supramesocolic area. The superior mesenteric artery could be visualized. However, CA could not be visualized from its origin despite extravasation around the CA. Therefore, a CA injury was suspected (Fig. 1). Subsequent abdominal angiography demonstrated that the CA terminated abruptly after its origin and celiac branches were visualized via superior mesenteric artery's collaterals (Fig. 2). As no other active bleeding was observed, an isolated CA injury was diagnosed. This finding suggested an intimal injury of the CA by blunt injury. An intra-aortic balloon occlusive catheter (AISIN SEIKI Co., Ltd., Aichi, Japan) was inserted via the right femoral artery and the balloon was placed above the CA without inflation, in case of re-bleeding during the subsequent surgery.During surgery, the left femoral artery and vein were initially exposed and taped in preparation for the possible need of extracorporeal circulation. This procedure was performed to preserve the infra-celiac aortic circulation in case cross clamping of the abdominal aorta during subsequent surgery become necessary. Fortunately, we did not need to inflate the intra-aortic balloon or to place the patient on extracorporeal circulation thereafter.A left-side thoracotomy and transection of the left diaphragm and upper laparotomy was performed. The aortic hiatus of the diaphragm was also transected to obtain sufficient exposure of the proximal aorta of the CA. At this time, medial mobilization of all left-sided intra-abdominal viscera was performed for visualization of the entire abdominal aorta. After that, the aorta was isolated and tapes were placed around the distal and proximal sides of the CA, in preparation for the cross clamping of the aorta. After removal of the hematoma, a careful dissection of the dense plexus of neural tissues and lymphatics was performed. A minor tear of the celiac trunk was visualized and the celiac trunk wa...

Isolated Dissection of the Celiac Artery after Blunt Trauma: A Case Report and Review of Literature

“…Isolated CA injury, which is an injury to the CA without concomitant aortic injury, is the least common among all abdominal arterial injuries. To date, only 8 reports of isolated CA injury following blunt trauma have been reported [2][3][4][5][6][7][8][9]. These cases, except for 1 case without a detailed description, are summarized, along with our two cases, in Table 1.…”

“…These cases, except for 1 case without a detailed description, are summarized, along with our two cases, in Table 1. All but one of the injuries (CA rupture managed by surgical ligation) [3], including our two cases, were CA dissections. In this report, we focus on the clinical presentation, treatment, and outcomes of these isolated CA dissections.…”

An uncommon cause of abdominal pain following blunt abdominal trauma

“…In the majority of cases, traumatic injury to the coeliac artery is associated with injury to other intra-abdominal organs, including the small bowel, duodenum, pancreas, colon or stomach. Only a few cases of isolated blunt traumatic injury to the coeliac axis have been reported [2][3][4][5]. The intimate anatomical relationship of the coeliac axis to the median arcuate ligament has been proposed as a factor contributing to isolated coeliac artery injury secondary to blunt trauma.…”

Asymptomatic Isolated Celiac Artery Dissection After a Fall

“…12 This intimate anatomic relationship, coupled with rapid deceleration and an anteroposterior crush, has been proposed as a possible mechanism of isolated injury to the CA in blunt trauma. 11,13 A fall from 900 cm, as occurred with our The management of CA injury has varied. Active hemorrhage from the CA is an emergency requiring prompt laparotomy with or without left thoracotomy to expose the root of the vessel and allow for its repair or ligation.…”

“…9-11 Linuma et al 11 described a tear in the CA diagnosed on initial CT that demonstrated extravasation of contrast media around the vessel's origin. The patient underwent left thoracotomy and upper laparotomy to ligate the CA at its base.…”