Spontaneous isolated dissection of the celiac trunk with rupture of the proximal splenic artery: a case report.
BACKGROUND
Spontaneous visceral artery dissection is an uncommon cause of acute abdominal pain. Complications are ischemia, aneurysm formation and rupture. We present a case with synchronous rupture of the splenic artery causing massive bleeding and demanding urgent surgery. To our knowledge, only 24 previous cases are reported in the literature.


METHODS
The patient was a 56-year-old male smoker with no previous medical history who was treated surgically with exposure of the suprarenal aorta through left-sided medial visceral rotation and isolation of the celiac artery. The origin of the bleeding was identified as a longitudinal rupture of the splenic artery just distal to the hepatic artery. The artery was ligated and splenectomy was performed because of splenic infarction. The hepatic artery was patent and no reconstruction was needed. The postoperative course was uneventful, treatment with antiplatelets and antihypertensive drugs was initiated. The patient was discharged after ten days and at monthly follow-up the patient was in good condition. CT angiography was performed six months postoperative and the celiac trunk was patent but a small aneurysm had developed.


CONCLUSIONS
Dissection of the celiac artery is uncommon and is rarely considered in the diagnosis of acute abdominal pain. The condition could be mistaken for a ruptured AAA. The condition may be underdiagnosed and it seems likely that more cases will be identified in the future as a result of the rapidly evolving vascular imaging modalities.
Nordanstig
J
J
Department of Surgery, Vascular Unit, Central Hospital of Karlstad, Rosenborgsgatan, Karlstad, Sweden. joakim@nordanstig.net
Gerdes
H
H
Kocys
E
E
D000006:Abdomen, Acute / Q000000981:diagnostic imaging / Q000209:etiology* / Q000601:surgery; D000328:Adult; D000368:Aged; D000784:Aortic Dissection / Q000150:complications / Q000175:diagnosis* / Q000000981:diagnostic imaging / Q000601:surgery; D000959:Antihypertensive Agents / Q000627:therapeutic use; D001027:Aortography; D002445:Celiac Artery / Q000000981:diagnostic imaging / Q000601:surgery; D003937:Diagnosis, Differential; D005260:Female; D006470:Hemorrhage / Q000000981:diagnostic imaging / Q000209:etiology* / Q000601:surgery; D006801:Humans; D008026:Ligation; D008297:Male; D008875:Middle Aged; D010975:Platelet Aggregation Inhibitors / Q000627:therapeutic use; D012422:Rupture, Spontaneous; D013156:Splenectomy; D013157:Splenic Artery / Q000000981:diagnostic imaging / Q000601:surgery; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome; D014656:Vascular Surgical Procedures
D000959:Antihypertensive Agents; D010975:Platelet Aggregation Inhibitors