Isolated Spontaneous Dissection of the Celiac Artery: Report of Two Cases

Abstract

IntroductionIsolated spontaneous dissection of the splanchnic arteries is rare. Among these disorders, dissection of the celiac artery (DCA) is especially rare. Obon-Dent 1) reported that only 33 reported cases of DCA were yielded by a Medline database search in 2012. The patients were treated by surgery, endovascular intervention and medical management in these reports, but the therapeutic strategy is still unclear and controversial.We report two cases of DCA, in which the patients were treated conservatively and observed carefully. Case ReportCase 1 A 58-year-old male smoker underwent enhanced computed tomography (CT) because of mild right hypogastralgia of 10-day duration and elevation of carcinoembryonic antigen (8.9 ng/mL) and carbohydrate antigen 19-9 (124 U/mL). He had had no episode of severe back or abdominal pain. Enhanced CT revealed solitary dissection of the celiac trunk, in which the common hepatic artery arose from the true lumen whereas the splenic artery arose from the false lumen (Fig. 1). He was admitted for further investigation. On admission, blood pressure was 134/72 mmHg and he had mild tenderness in the epigastrium and right hypogastrium, which gradually resolved over several days. Laboratory data showed slight elevation of white blood cell count (10100/µL) and hemoglobin (16.8 g/dL), but C-reactive protein (CRP) was normal. Esophagogastroduodenoscopy and total colonoscopy showed no pathological change except atrophic gastritis. He was orally administered a β-blocker to decrease blood pressure mildly, but no antiplatelet or anticoagulant drugs, and was discharged nine days after admission. Isolated spontaneous dissection of the celiac artery (DCA) is extremely rare and its therapeutic strategy is still not established. We report two cases of DCA, in which 58-year-old and 43-year-old male patients with right hypogastralgia and back pain, respectively, were diagnosed by enhanced computed tomography and treated conservatively with antihypertensive agents. They were doing well under circumspect medical management without recurrence of symptoms or progression of dissection after 3.5 years and 3 months, respectively, after detection of DCA. Conservative treatment with blood pressure control and careful surveillance is considered to be applicable in most cases of DCA. Isolated Spontaneous

Current status of spontaneous isolated celiac artery dissection

“…In this analysis, the misdiagnosis rate was 3.16% (10/316). The most common misdiagnoses were pancreatitis, 14,15 gastritis, ureteral stone, 16 lymphadenopathy, enteritis, 17,18 peptic ulcer, 19 and pancreas cancer. 20,21 Several risk factors can lead to SI-CAD, including a history of smoking, a higher abdominal pressure, [22][23][24][25][26][27][28] vasculitis, 29 autoimmune disorders, 30,31 food consumption, [32][33][34] median arcuate ligament compression syndrome, 8,35 fibrous dysplasia, 27 and myxoid degeneration of the tunica media (Table 2).…”

Spontaneous dissections of multiple visceral arteries: an extremely rare case

“…Once the SMA is sufficiently reperfused, flow to the CA improves. Therefore, a CA dissection would rarely lead to any serious sequelae when the dissection is limited to the celiac trunk in the acute or early phase [10]. Increased serum creatinine, leukocytosis and markedly increased levels of serum LDH and evidence of renal infarction on the CT were consistent with renal parenchymal cell death [3].…”

Dissection of the Celiac Artery

“…13 Fortunately, DCA is rarely accompanied by fatal organ dysfunction due to collateral flow from other vessels. 14…”