Common Celiacomesenteric Trunk Presenting with Mesenteric Ischemia: 2 Case Reports with a Review of the Literature

1University of Hawaii, Honolulu, HI
2University of Hawaii, Honolulu, HI
3University of Hawaii, Honolulu, HI

Meeting: Hospital Medicine 2013, May 16-19, National Harbor, Md.

Abstract number: 373

Case Presentation:

We present 2 cases demonstrating variant branching of the abdominal aortic trunks along with radiographic imaging and correlation to a common disease state. The first case is a 67‐year‐old woman who presented with abrupt onset of rapidly worsening abdominal pain. Computed tomography demonstrated pneumatosis intestinalis with air in both the hepatic portal system and superior mesenteric veins. A celiacomesenteric trunk (CMT) was noted to originate from the aorta at T12 replacing separate superior mesenteric artery (SMA) and celiac trunk (CT). The patient was taken for exploratory laparotomy, which revealed a 60‐cm length of ischemic bowel, which was resected. The second case was an 88‐year‐old man with recurrent GI bleeding accompanied by severe abdominal pain. Enteroscopy revealed a dusky section of the proximal duodenum with bleeding duodenal ulcerations, which are pathognomonic for chronic mesenteric ischemia. Angiography demonstrated CMT with high‐grade stenosis. The CMT was stented open improving flow and reperfusing the bowel. The ischemic portion of the bowel recovered with out required resection

Discussion:

Chronic mesenteric ischemia remains an elusive diagnosis based on symptoms of intestinal angina supported by demonstration of high‐grade stenosis in multiple mesenteric vessels. The number of vessels that must be involved before symptom onset remains a debate. Gradual, progressive stenosis of one or more of the major mesenteric vessels is generally well tolerated because of the abundant collateral circulation that exists among the mesenteric vessels. CMT is a rare variation reported to occur in less than 1% of the population and is associated with an intrinsic loss of SMA‐CT collateral circulation. In these instances the collateral circulation between SMA and the celiac artery, an important safeguard protecting against mesenteric ischemia, is absent, leaving the bowel with one dominant vascular feed. Episodes of significant abdominal pain in this setting merit a low threshold for investigation and revascularization.

Conclusions:

We present two cases of symptomatic mesenteric ischemia in patients with celiacomesenteric trunk (CMT). Although rare, the presence of CMT has important clinical implications. The lack of collateral protection when CMT is compromised by atherosclerosis places the viscera at higher risk of ischemia. These cases together with a review of literature and discussion of the embryological development introduce a mechanism and provide anecdotal association between CMT and a predisposition to mesenteric ischemia.

Sagital CT (left) of CMT with intrahepatic portal gas and 3‐D reconstruction (right).

To cite this abstract:

Addicott B, Nguyen M, Pedro P. Common Celiacomesenteric Trunk Presenting with Mesenteric Ischemia: 2 Case Reports with a Review of the Literature. Abstract published at Hospital Medicine 2013, May 16-19, National Harbor, Md. Abstract 373. Journal of Hospital Medicine. 2013; 8 (suppl 2). https://www.shmabstracts.com/abstract/common-celiacomesenteric-trunk-presenting-with-mesenteric-ischemia-2-case-reports-with-a-review-of-the-literature/. Accessed November 15, 2019.

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