CASE REPORT: Spontaneous Dissection of the Celiac Artery: A Pitfall in the Diagnosis of Acute Abdominal Pain. Presentation of Two Cases

Fenoglio, Luigi; Allione, Attilio; Scalabrino, Elisa; Alberto, G; Benedetti, Valentina; Pomero, Fulvio; Valpreda, S; Morino, Mario; Perin, Paolo Cavallo

doi:10.1023/b:ddas.0000037816.57229.6f

Cited by 56 publications

(55 citation statements)

References 9 publications

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“…Intimal delamination is pathognomic to dissection in the artery under evaluation. Other suggestive findings are celiac trunk aneurysm, wall thrombus, celiac trunk segmental stenosis and unspecific inflammatory infiltrate in fat adjacent to the vessel affected 5,18 . Abdominal MRI does not require iodated contrasts, has sensitivity similar to that of CT for lesions of the primary arterial branches and differentiates recent thrombi from chronic ones, but requires more time for its performance, has higher costs and is less accessible to the population.…”

Section: Discussionmentioning

confidence: 99%

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Dissecção espontânea do tronco celíaco: qual a melhor abordagem terapêutica?

et al. 2013

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Spontaneous dissection of visceral arteries is a rare event. Sudden abdominal pain in the epigastrium is the most frequent symptom. Advances in imaging techniques have made it easier to diagnose this event, increasing the incidence of visceral artery dissection. Conservative clinical treatment, surgical revascularization and endovascular repair are the three treatment options available. We describe two cases of patients with spontaneous dissection of the celiac trunk that received different treatments based on their clinical presentation and imaging studies. We also conducted a review of studies about this condition in the literature.Keywords: celiac trunk; spontaneous dissection; endovascular. ResumoA dissecção espontânea das artérias viscerais é um evento relativamente raro. Dor abdominal súbita no epigástrio é o sintoma mais frequentemente manifestado pelos pacientes. O avanço das técnicas de exames de imagem possibilitou o diagnóstico deste evento com maior facilidade, aumentando a incidência das dissecções das artérias viscerais. O tratamento clínico conservador, a revascularização cirúrgica, e a terapia endovascular são as três possíveis opções terapêuticas. Neste artigo, relatamos os casos de dois pacientes com dissecção espontânea do tronco celíaco conduzidos de formas diversas, de acordo com a apresentação clínica e exames de imagem, além de realizar uma revisão bibliográfica sobre esta doença.Palavras-chave: tronco celíaco; dissecção espontânea; endovascular.

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Section: Discussionmentioning

confidence: 99%

“…[13][14][15][16][17][18][19][20] Technical advances and the growing use of imaging methods to investigate its etiology in patients with abdominal pain led to an increase in the incidence of the diagnosis of SDVA 2,21 .…”

Section: Introductionmentioning

confidence: 99%

Dissecção espontânea do tronco celíaco: qual a melhor abordagem terapêutica?

et al. 2013

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“…2 Conditions that have been identified as causing arterial dissection include arterial hypertension, atherosclerosis, trauma, iatrogeny, pregnancy, syphilis, polyarteritis nodosa, fibromuscular dysplasia, cystic degeneration of the media (Marfan Syndrome) and other congenital disorders of vessel walls (Ehlers-Danlos Syndrome, for example). 5,7 Other precipitating events can include mechanical stretching and microtraumas caused by effort or by rapid increases in intra-abdominal pressure, such as, for example, sneezing or standing up. However, in the majority of cases of isolated spontaneous dissection of the celiac trunk the cause remains unknown.…”

Section: Casementioning

confidence: 99%

“…The objectives of conservative clinical treatment do not only include preventing progression of the dissection by controlling arterial blood pressure, but also extend to avoiding thromboembolic complications through administration of anticoagulants. 3,4,8 In view of this, 3 to 6 months' treatment with anticoagulant agents or antiplatelet drugs, aiming for a target international normalized ratio (INR) of 2.0 to 3.0, in combination with strict control of arterial blood pressure 5,7 have been recommended for prevention of thromboembolic complications. Administration of an anticoagulant immediately after diagnosis induces healing of the dissection and dissolution of the mural hematoma while preventing thromboembolic complications.…”

Section: Casementioning

confidence: 99%

“…2,3 Surgical or endovascular interventions should be considered in the following situations: when the patient is hemodynamically unstable or has persistent abdominal pain, when conservative medical treatment fails to control arterial blood pressure and when the dissection is progressing further. 2,3,7 This can be investigated through serial follow-up using imaging methods, but to date there is no established consensus on the frequency with which these examinations should be conducted. 2 If angiotomography shows active contrast leakage from the celiac trunk, emergency laparotomy is the treatment of choice.…”

Section: Casementioning

confidence: 99%

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Spontaneous dissection of the celiac trunk: report of three cases and review of the literature

2014

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Spontaneous dissection of the celiac trunk is quite an uncommon medical condition, with few case reports in the medical literature. Sudden epigastric abdominal pain is the most common complaint reported by patients, but due to the rarity of this disease in clinical practice and the nonspecific nature of its symptoms, a high degree of clinical suspicion is needed to establish diagnosis. However, improvements in imaging techniques are facilitating diagnosis of this clinical entity, increasing its detection rate. The ideal treatment has not yet been fully established in the literature and the available therapeutic strategies are conservative medical treatment, surgical revascularization or endovascular intervention. In this article we report on three cases of spontaneous dissection of the celiac trunk and conduct a review of the literature on this disease Keywords: dissection; acute pain; celiac artery. ResumoA dissecção espontânea do tronco celíaco é uma condição médica incomum, com poucos relatos de casos publicados na literatura médica. A dor abdominal súbita no epigástrio é o sintoma mais frequentemente manifestado pelos pacientes; porém, devido à raridade dessa doença na prática clínica e à inespecificidade de seus sintomas, é necessário um alto grau de suspeição para o estabelecimento do seu diagnóstico. Nesse contexto, o aperfeiçoamento das técnicas de exames de imagem vem possibilitando o diagnóstico desta entidade clínica com maior facilidade, aumentando a sua taxa de detecção. O tratamento ideal ainda não está completamente bem estabelecido na literatura, sendo que as estratégias terapêuticas disponíveis são o tratamento médico conservador, a revascularização cirúrgica e a intervenção endovascular. Neste artigo, nós relatamos três casos de dissecção espontânea do tronco celíaco e realizamos uma revisão de literatura sobre esta doença.Palavras-chave: dissecção; dor aguda; artéria celíaca.

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Asymptomatic Isolated Celiac Artery Dissection After a Fall

Gorra

Mittleider²,

Clark³

et al. 2009

Arch Surg

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Isolated injury to mesenteric vessels in blunt trauma is uncommon. Most patients with these injuries present with abdominal pain, shock, or laboratory evidence of bowel and/or liver ischemia. We report herein the case of a man with asymptomatic isolated celiac artery dissection after blunt trauma suspected by screening abdominal computed tomography and confirmed by catheter-based angiography. The patient was treated with 3 months of oral anticoagulation alone.

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CASE REPORT: Spontaneous Dissection of the Celiac Artery: A Pitfall in the Diagnosis of Acute Abdominal Pain. Presentation of Two Cases

Cited by 56 publications

References 9 publications

Dissecção espontânea do tronco celíaco: qual a melhor abordagem terapêutica?

Dissecção espontânea do tronco celíaco: qual a melhor abordagem terapêutica?

Spontaneous dissection of the celiac trunk: report of three cases and review of the literature

Asymptomatic Isolated Celiac Artery Dissection After a Fall

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