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

Abstract

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.

Spontaneous Isolated Inferior Mesenteric Artery Dissection With Chronic Mesenteric Ischemia: Case Report and Endovascular Management

“…Spontaneous isolated dissection of the visceral arteries is uncommon, with SMA being commonly affected followed by celiac trunk, splenic artery, and rarely IMA. 1 –3 Only a single case of spontaneous dissection of IMA is reported in the English literature. 4 The extremely low incidence may be an underestimation due to the fact that isolated dissections of IMA are clinically silent or with mild symptoms due to abundant collateral circulation from the SMA and hypogastric artery.…”

“…Etiology of visceral artery dissections is varied, including atherosclerosis, cystic medial necrosis (Marfan syndrome, Ehler-Danlos type IV), trauma, iatrogenic, syphilis, pregnancy, fibromuscular dysplasia, segmental artery mediolysis, and inflammatory arteritides such as Takayasu arteritis and polyarteritis nodosa. 1,5 –7 Arterial hypertension is a predisposing factor. 1,5…”

“…Secondary signs include unexplainable dilatation of the vessel, periarterial stranding, tapered occlusion of the vessel, and eccentric mural thrombus in vessel. 1,4 Invasive angiography is gold standard for visceral artery dissections and may aid in therapeutic treatment as well. 1…”

“…1,4 Invasive angiography is gold standard for visceral artery dissections and may aid in therapeutic treatment as well. 1…”

“…Management options are debatable not only because of rarity of disease but also because it depends on clinical presentation of the patient, response to conservative treatment, involvement of other vessels, and development of complications. 1 Spontaneous isolated dissections of visceral arteries are usually managed surgically if the patient has acute symptoms with suspicion of mesenteric ischemia. 5 Colon ischemia is the most common complication and is managed by a multidisciplinary approach including supportive care, watchful observation, conservative medical management, intravenous fluids, and bowel rest.…”