Spontaneous celiac artery dissection complicated by gallbladder wall necrosis. A case report and literature review
Panagiotis Drakos, MD, Spyridon Monastiriotis, MD, Edvard Skripochnik, MD, Polikseni Eksarko, MD, Apostolos Tassiopoulos, MD.
Stony Brook, Stony Brook, NY, USA.
OBJECTIVES: Celiac artery dissection complicated by downstream visceral ischemia is a rare and potentially life-threatening event. Consensus over the treatment strategies remains to be defined.
METHODS: We report a case of a 58-year-old male with spontaneous dissection of the celiac artery. The patient presented with acute onset abdominal pain radiating to his back. CT scan of the abdomen revealed an isolated celiac artery dissection with intramural hematoma extending into the common hepatic artery causing a 3-cm segment of high-grade stenosis
RESULTS: Due to persistent abdominal pain and elevation of liver function tests (LFTs), a gallbladder ultrasound was obtained showing significant wall thickening. Exploratory laparoscopy revealed patchy necrosis of the gallbladder and a laparoscopic cholecystectomy was performed. Postoperatively, oral anticoagulation and antiplatelet treatment were started to prevent hepatic artery thrombosis. Due to recurrent episodes of hematuria, temporary cessation of anticoagulation was required during which LFTs elevation and abdominal pain recurrence were observed. Repeat CTA showed progression of the celiac artery dissection with near-complete occlusion of the common hepatic artery and distal reconstitution. Resumption of anticoagulation led to abdominal pain resolution and LFTs normalization. Duplex ultrasound 3 months after the initial presentation showed significant improvement of the common hepatic artery stenosis and normal LFTs.
CONCLUSIONS: There is no consensus regarding best management of spontaneous celiac artery dissection. Open surgical or endovascular intervention is required in cases of significant liver ischemia, but anticoagulation remains the first line of treatment. A high index of suspicion of end organ malperfusion must be maintained in all cases
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