Spontaneous dissection of celiac trunk with concurrent splenic artery dissection

Abstract

Isolated spontaneous dissection of the celiac trunk is rarely diagnosed in acute abdominal pain. We present two cases of celiac trunk and splenic artery dissection with splenic infarction. Patients were successfully managed and stabilized by medical treatment. Isolated celiac trunk dissection can be fatal, therefore providers should be careful not to overlook this entity.

Spontaneous isolated celiac and splenic artery dissection with splenic infarction

“…It is widely believed that reports of all spontaneous isolated visceral artery dissections will continue to increase over time as diagnostic imaging modalities improve and become more prevalent [6] , [25] . Indeed, our search found 18 additional cases of splenic artery dissection, bringing the number of reported cases to 42, including our case [3] , [4] , [5] , [6] , [8] , [9] , [24] . Males in 5th or 6th decade of life are at highest risk.…”

“…Most patients are managed medically, consisting of either anti-platelet, anti-coagulation, both, or with observation alone. Anti-hypertensive and pain control regiments are used when indicated [4] , [6] , [8] , [9] , [12] , [13] , [20] , [22] , [23] , [24] , [25] . In a review of 77 patients with either spontaneous isolated SMA or celiac artery dissection, Morgan found that asymptomatic patients tended to be treated with anti-platelet therapy alone while symptomatic patients were treated with anticoagulation [11] .…”

“…Nowadays, patients tend to have favorable outcomes, with resolution of symptoms and minimal reported further complications. Except for the two aforementioned cases of splenectomy, patients appear to recover well from splenic infarct without long term sequelae [3] , [4] , [4] , [6] , [8] , [9] , [10] , [12] , [14] , [15] , [20] , [23] , [24] , [25] . Follow up imaging has demonstrated stable dissection and splenic scaring as far out as 2 years from presentation [24] .…”

Disección espontánea del tronco celíaco. Una emergencia vascular inusual

“…En la revisión sistemática publicada por Cavalcante et al, el manejo fue conservador en un 79,1 %, endovascular en un 11,8 % y quirúrgico en un 8,9 % de los casos. Se ha reportado que, sin importar la morfología de la disección, la mayoría de los casos se manejan de forma conservadora con tratamiento antihipertensivo, con o sin terapia anticoagulante y antiagregante 4,[18][19][20] . La terapia anticoagulante se fundamenta en el alto riesgo de trombosis de las arterias viscerales dado su menor diámetro y flujo más lento en comparación con la aorta 21 .…”

“…Si bien la meta del manejo médico es evitar la progresión de la disección y las complicaciones tromboembólicas 18 , se ha descrito que hasta un tercio de los pacientes requieren posteriormente algún tipo de intervención 21 . La literatura describe que, si se prevé anticoagulación por más de seis meses o si persiste el dolor o los síntomas y signos de isquemia intestinal o visceral progresiva, estarán indicadas medidas intervencionistas como manejo endovascular con prótesis y revascularización quirúrgica mediante resección del segmento disecado y anastomosis o baipás, e implantación de prótesis endovasculares en la arteria comprometida [4][5][6]18,[20][21] . En el caso presentado, ante la sospecha clínica y paraclínica de isquemia en curso, se optó por manejo endovascular obteniendo un resultado exitoso, logrando un flujo arterial satisfactorio y la desaparición del dolor luego del implante de la prótesis.…”