Recurrent Mesenteric Ischemia from Celiomesenteric Trunk Stenosis

Abstract

A common origin of the celiac trunk and superior mesenteric artery (SMA), also termed as celiomesenteric trunk (CMT), is a rare occurrence. We report a rare case of symptomatic CMT stenosis requiring multiple interventions. The patient underwent an initial superior mesenteric artery bypass graft but required a subsequent endoluminal intervention. We present this case for the rarity of CMT stenosis and its potential to cause recurrent mesenteric ischemia. The treatment outcome in this patient suggests that revascularization of the SMA alone can result in adequate perfusion of the entire mesenteric bed and resolve symptoms of mesenteric ischemia including weight loss and food avoidance.

Asymptomatic stenosis of a celiacomesenteric trunk

“…To our knowledge, atheromatous stenosis of CMT was reported in the literature in only 6 cases [7] . Patients were symptomatic with mesenteric angina, weight loss, and dyspepsia.…”

Diagnostic and Surgical Implications of Non-occlusive Mesenteric Ischemic Ileus Associated With Common Celiacomesenteric Trunk: A Case Report and Literature Review

“…The patient exhibited stenosis related to a CMT and was successfully treated using an endovascular technique [ 12 ]. In addition to endovascular approaches, open bypass graft placement has been utilized in certain cases to re-perfuse stenotic CMT in those presenting with recurrent mesenteric ischemia [ 13 ].…”

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.…”

“… 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.…”