Intestinal ischemia in a patient with vascular malformation: a recipe for disaster

Abstract

Anatomical variations of the celiac and mesenteric artery have been described over the past two centuries; many of these variations will have no clinical repercussions and will only be found incidentally or during imaging studies. However, these variations can lead to severe complications if undetected during surgery, transplantation or when they are affected by ischemia. Therefore, prompt treatment is needed to overcome these dangerous scenarios. We present the case of a 71-year-old patient who had a celiacomesenteric trunk and developed transient intestinal ischemia; however, he suffered severe acidosis and hyperlactatemia that ultimately led to organ failure and death.

Successful endovascular treatment of acute mesenteric and hepatic ischemia in patient with celiomesenteric trunk occlusion

“…A replaced common hepatic artery (RCHA) from the superior mesenteric artery (SMA) is one of the variants of the celiomesenteric trunk and is rare, occurring in 1.13% of 19,013 cases in the largest systematic review of the literature. 1 Patients with an RCHA can require vascular intervention for acute and chronic ischemia, 2 , 3 , 4 , 5 , 6 , 7 aneurysms, 8 , 9 dissection, 10 and median arcuate ligament syndrome. 8 Reports of patients with mesenteric ischemia in the setting of a celiomesenteric trunk variant have described excellent clinical results with thoughtful and timely open and endovascular intervention.…”

“… 4 , 5 , 9 , 11 Other reports have acknowledged that mesenteric ischemia in a patient with a celiomesenteric trunk presents diagnostic and therapeutic challenges but that delay in definitive treatment has lethal consequences. 3 , 6 , 12 We report the case of a 73-year-old woman with acute occlusion of her celiomesenteric trunk who underwent successful endovascular repair. She was cachectic, with months of food fear and weight loss, and presented with severe acute abdominal pain.…”

“…The terms currently used in the literature include replaced common hepatic artery (or RCHA), celiomesenteric trunk, celiacomesenteric trunk, and quadrification, among others. 3 , 6 , 7 , 9 , 11 , 13 The aberrant origin of some of these arteries is likely related to the persistence of vitelline arteries during embryologic development. 14 Previous classification systems of these anomalies failed to provide the level of anatomic detail required by surgeons and interventionists planning revascularization.…”