Spontaneous Isolated Celiac Artery and Superior Mesenteric Artery Dissections: A Rare Case

Abstract

SummaryBackgroundArterial dissection is defined as the cleavage of the arterial wall by an intramural hematoma. Reports of dissection of the celiac and/or superior mesenteric artery are rare; as far as we know, only 24 cases of spontaneous isolated celiac trunk dissection, and 71 cases of spontaneous isolated superior mesenteric artery dissection have been reported.Case ReportThe case presents a 48-year-old male with a sudden-onset epigastric pain. A Computed Tomography Angiography of the thoracoabdominal aorta was applied and dissections of both the celiac artery and SMA were determined. A conservative therapeutic approach was preferred and the patient was discharged with anticoagulant and antihypertensive therapy.ConclusionsAlthough rare, spontaneous isolated celiac artery and superior mesenteric artery dissections must be kept in mind in the differential diagnosis of the epigastric pain in the emergency room. Contrast-enhanced Computed Tomography Angiography examination is the method of choice in the diagnosis.

Spontaneous Isolated Superior Mesenteric Artery Dissection

“…The initial symptom in most patients is acute epigastric pain due to intestinal ischemia, although some asymptomatic cases can be detected as incidental finding on imaging. Chronic or subacute dissection may present with additional symptoms such as postprandial abdominal pain and weight loss [11, 12]. We hereby present and discuss the case of an isolated spontaneous dissection of SMA at our institution.…”

Hypertensive emergency presenting with an isolated celiac artery dissection: A rare case study

“…To our knowledge the most recent article on celiac dissection was published in 2015 and reported 24 known cases of spontaneous isolated celiac trunk dissection [2] . In our literature review we did not identify a single case of isolated celiac artery dissection that presented during a hypertensive emergency.…”

“…The definition of an arterial dissection is the cleavage of the arterial wall by an intramural hematoma located between two elastic layers [2] , [4] . As we are reporting the 25th known case of celiac artery dissection, it remains a rare entity.…”

“…As we are reporting the 25th known case of celiac artery dissection, it remains a rare entity. Many of the other reported cases involve other arteries such as the common hepatic, splenic, superior mesenteric, and gastroduodenal [1] , [2] , [4] , [9] , [10] , [11] , [12] . Additionally, while some of those cases reported hypertension as a risk factor, no other case presents as hypertensive emergency with an isolated celiac artery dissection.…”

“…Additionally, while some of those cases reported hypertension as a risk factor, no other case presents as hypertensive emergency with an isolated celiac artery dissection. The first case of visceral artery dissection involved the superior mesenteric artery (SMA) and was reported in 1947, while the first celiac artery dissection was not reported until 1959 [2] . More commonly, arterial dissections occur in the carotid and renal arteries [4] .…”