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Ishimine T, Ishigami T, Chida K, Kawasaki K, Taniguchi N, Tengan T. Diagnosis and treatment of isolated celiac artery dissection following blunt trauma: A case report. Int J Surg Case Rep 2021; 89:106617. [PMID: 34861546 PMCID: PMC8640449 DOI: 10.1016/j.ijscr.2021.106617] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2021] [Revised: 11/13/2021] [Accepted: 11/16/2021] [Indexed: 11/05/2022] Open
Abstract
Introduction Celiac artery (CA) dissection due to blunt abdominal trauma is extremely rare and, as such, the clinical features of this potentially life-threatening injury have not been clearly defined, nor have treatment strategies been established. Presentation of case We describe the case of a 61-year-old man who presented to our emergency department after a motor vehicle accident. Although the patient did not report abdominal pain, enhanced computed tomography (CT) revealed CA dissection. The patient was treated conservatively using antiplatelet therapy and was discharged from the hospital on day 8, without complications. Discussion As abdominal pain is not a common presenting factor of CA dissection after blunt trauma, it should be suspected as a potential injury in all affected patients and comprehensively assessed, with CT being the most useful diagnostic modality. Conclusion In the absence of any signs of organ ischemia, changes in the CA aneurysm, and persistent, severe abdominal pain following blunt abdominal trauma, conservative treatment is indicated, with or without anticoagulation or antiplatelet therapy. Celiac artery (CA) dissection due to blunt abdominal trauma is extremely rare. We describe a case of CA dissection after a motor vehicle accident. Enhanced computed tomography revealed the CA dissection. The patient was treated conservatively and was discharged from hospital on day 8.
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Affiliation(s)
- Tohru Ishimine
- Department of Cardiovascular Surgery, Okinawa Chubu Hospital, 281, Miyazato, Uruma-shi, Okinawa 904-2293, Japan.
| | - Takahiro Ishigami
- Department of Cardiovascular Surgery, Okinawa Chubu Hospital, 281, Miyazato, Uruma-shi, Okinawa 904-2293, Japan
| | - Kohei Chida
- Department of Cardiovascular Surgery, Okinawa Chubu Hospital, 281, Miyazato, Uruma-shi, Okinawa 904-2293, Japan
| | - Kyohei Kawasaki
- Department of Cardiovascular Surgery, Okinawa Chubu Hospital, 281, Miyazato, Uruma-shi, Okinawa 904-2293, Japan
| | - Naoki Taniguchi
- Department of Cardiovascular Surgery, Okinawa Chubu Hospital, 281, Miyazato, Uruma-shi, Okinawa 904-2293, Japan
| | - Toshiho Tengan
- Department of Cardiovascular Surgery, Okinawa Chubu Hospital, 281, Miyazato, Uruma-shi, Okinawa 904-2293, Japan
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Li H, Zhao Y, Xu YA, Li T, Yang J, Hu P, Ai T. Acute celiac artery occlusion secondary to blunt trauma: Two case reports. World J Clin Cases 2020. [DOI: 10.12998/wjcc.v8.i23.6157] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023] Open
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Li H, Zhao Y, Xu YA, Li T, Yang J, Hu P, Ai T. Acute celiac artery occlusion secondary to blunt trauma: Two case reports. World J Clin Cases 2020; 8:6164-6171. [PMID: 33344619 PMCID: PMC7723708 DOI: 10.12998/wjcc.v8.i23.6164] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/22/2020] [Revised: 09/27/2020] [Accepted: 10/20/2020] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND Acute celiac artery (CA) injuries are extremely rare but potentially life-threatening and are more often caused by a penetrating injury rather than a blunt injury. The clinical manifestation of CA injuries is usually atypical, which easily causes missed diagnosis and misdiagnosis. Currently, there are only a few reports of acute traumatic occlusion of CA. The CA artery gives off branches to dominate the liver, stomach. and spleen; however, occluded CA did not cause significant organ ischemia, and the compensatory blood flow from the superior mesenteric artery (SMA) played a pivotal role.
CASE SUMMARY Herein, we report two cases of acute CA occlusion secondary to severe blunt trauma. Case one was a 19-year-old male, suffered from a motorcycle crash. He complained of dyspnea, and the closed drainage was performed soon after the hemopneumothorax was confirmed by ultrasound. Computed tomography (CT) scan revealed hemopneumothorax, multiple rib fractures, right scapular fracture, and liver rupture. Reexamination with contrast-enhanced CT suggested perihepatic fluid was significantly increased, and CA was occluded. Because the hepatic hemorrhage is associated with hepatic artery injury, the CA was retrogradely opened through the SMA, and then, the right hepatic artery was embolized with coils successfully through the conventional pathway. Stent implantation was not performed, and the CA occlusion was managed by conservative treatment. A follow-up CT scan 3 mo after discharge showed the origin of CA remained occluded. Case two was a 37-year-old man, suffered injury from fall from height. He complained of lower back and bilateral heel pain. Contrast-enhanced CT examination revealed multiple rib fractures, bilateral pneumothorax, fourth lumbar (L4) vertebral burst fracture, and pelvic fractures. Furthermore, a small high-density mass in a lesser peritoneal sac and in front of the abdominal aorta was detected. The reexamination 14 h after admission showed the CA was occluded. The patient was conservatively treated. The symptoms of nausea after meals disappeared about 4 wk later, and abdominal distension was significantly relieved after 6 wk. The abdominal CT angiography at 60 d showed that the CA thrombus was not recanalized.
CONCLUSION Patients with CA occlusion will have different clinical manifestations, and the dominant organ will not have obvious ischemia. Conservative treatment is safe, and the patient’s symptoms will be improved with the establishment of collateral circulation.
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Affiliation(s)
- Hui Li
- Department of Traumatology, Chongqing University Central Hospital, Chongqing 400080, China
| | - Yu Zhao
- Department of Radiology, Chongqing University Central Hospital, Chongqing 400080, China
| | - Yan-An Xu
- Department of Traumatology, Chongqing University Central Hospital, Chongqing 400080, China
| | - Tao Li
- Department of Traumatology, Chongqing University Central Hospital, Chongqing 400080, China
| | - Jun Yang
- Department of Traumatology, Chongqing University Central Hospital, Chongqing 400080, China
| | - Ping Hu
- Department of Traumatology, Chongqing University Central Hospital, Chongqing 400080, China
| | - Tao Ai
- Department of Traumatology, Chongqing University Central Hospital, Chongqing 400080, China
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Birkl J, Kahl T, Thielemann H, Mutze S, Goelz L. Retrospective Analysis and Systematic Review of Isolated Traumatic Dissections of the Celiac Artery. Ann Vasc Surg 2020; 66:250-262. [PMID: 31923601 DOI: 10.1016/j.avsg.2020.01.005] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2019] [Revised: 12/14/2019] [Accepted: 01/01/2020] [Indexed: 11/26/2022]
Abstract
BACKGROUND Isolated dissections of the celiac artery (CA) after blunt trauma are rarely described. This retrospective analysis and systematic review analyzes epidemiology, radiologic examinations, patterns of injuries, therapeutic measures, clinical courses, and outcomes. METHODS Retrospective analysis of polytraumatized patients admitted between 1997 and 2012 to a trauma center level I. Systematic literature search was carried out on pubmed.gov, eurorad.org, and google.com. RESULTS Isolated traumatic dissections of the CA had an incidence of 0.17% in a retrospective collective (n = 9). Mean age was 31.7 years in 6 male (66.7%) and 3 female (33.3%) patients. Systematic literature search identified 12 primary sources describing 13 males (100%) with a mean age of 41.3 years. Traffic accidents and falls were the most common causes of injury. An intimal flap (77.7%) and a thrombosed false lumen (59.1%) were the most common computed tomographic findings. Twenty-two patients were analyzed, and 16 patients were treated conservatively. The CA was bypassed in 2 symptomatic patients. One patient was treated with a stent. Two patients died because of massive bleeding, and 1 patient died because of liver failure. About 19 discharged patients were asymptomatic on follow-up. Long-term follow-up with magnetic resonance angiography showed stable dissections (n = 1), medium stenosis (n = 1), resolution of the dissection (n = 2), high-grade stenosis of the CA combined with a small pseudoaneurysm (n = 1), or occlusion of the CA with sufficient collateralization (n = 3). Pharmaceutical treatment was individualized with low-molecular-weight heparin, heparin, or warfarin, and acetylicsalicylic acid. CONCLUSIONS Traumatic CA dissections are mostly caused by traffic accidents and falls. Visceral perfusion should be monitored clinically and radiologically. Beginning visceral ischemia requires early invasive treatment. Endovascular and open surgery are possible options. Benefits of specific pharmaceuticals are still up for debate. Follow-up via magnetic resonance imaging or computed tomography angiography is essential to rule out vascular complications. LEVEL OF EVIDENCE III (Retrospective therapeutic study and systematic literature review).
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Affiliation(s)
- Jens Birkl
- Department of General Surgery, Unfallkrankenhaus Berlin, Berlin, Germany; Department of General Surgery, Albertinen Krankenhaus Hamburg, Hamburg, Germany
| | - Thomas Kahl
- Department of Radiology and Neuroradiology, Unfallkrankenhaus Berlin, Berlin, Germany
| | - Henryk Thielemann
- Department of General Surgery, Unfallkrankenhaus Berlin, Berlin, Germany
| | - Sven Mutze
- Department of Radiology and Neuroradiology, Unfallkrankenhaus Berlin, Berlin, Germany; Department for Diagnostic Radiology and Neuroradiology, University Medicine Greifswald, Greifswald, Germany
| | - Leonie Goelz
- Department of Radiology and Neuroradiology, Unfallkrankenhaus Berlin, Berlin, Germany; Department for Diagnostic Radiology and Neuroradiology, University Medicine Greifswald, Greifswald, Germany.
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Lee SB, Jung HJ, Kim JH. Symptomatic Isolated Celiac Artery Dissection following Blunt Trauma. JOURNAL OF ACUTE CARE SURGERY 2019. [DOI: 10.17479/jacs.2019.9.2.76] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
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Han A, Gwak J, Choi G, Park JJ, Yu B, Lee GJ, Kang JM. Isolated Dissection of the Celiac Artery after Blunt Trauma: A Case Report and Review of Literature. JOURNAL OF TRAUMA AND INJURY 2017. [DOI: 10.20408/jti.2017.30.4.220] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023] Open
Affiliation(s)
- Ahram Han
- Department of Trauma Surgery, Gachon University Gil Medical Center, Incheon, Korea
| | - Jihun Gwak
- Department of Trauma Surgery, Gachon University Gil Medical Center, Incheon, Korea
| | - Gangkook Choi
- Department of Trauma Surgery, Gachon University Gil Medical Center, Incheon, Korea
| | - Jae Jeong Park
- Department of Trauma Surgery, Gachon University Gil Medical Center, Incheon, Korea
| | - Byungchul Yu
- Department of Trauma Surgery, Gachon University Gil Medical Center, Incheon, Korea
| | - Gil Jae Lee
- Department of Trauma Surgery, Gachon University Gil Medical Center, Incheon, Korea
| | - Jin Mo Kang
- Department of Surgery, Gachon University Gil Medical Center, Incheon, Korea
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Kronick MD, Doben AR, Morris ME, Gross RI, Kravetz A, Nahmias JT. Blunt traumatic celiac artery avulsion managed with celiac artery ligation and open aorto-celiac bypass. Trauma Case Rep 2017; 11:8-12. [PMID: 29644269 PMCID: PMC5887052 DOI: 10.1016/j.tcr.2017.10.002] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/16/2017] [Indexed: 12/20/2022] Open
Abstract
Traumatic celiac artery injuries are rare and highly lethal with reported mortality rates of 38–62%. The vast majority are caused by penetrating trauma with only 11 reported cases due to blunt trauma (Graham et al., 1978; Asensio et al., 2000, 2002). Only 3 of these cases were complete celiac artery avulsions. Management options described depend upon the type of injury and have included medical therapy with anti-platelet agents or anti-coagulants, endovascular stenting, and open ligation. We report a case of a survivor of complete celiac artery avulsion from blunt trauma managed by open bypass.
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Affiliation(s)
- Matthew D Kronick
- Baystate Medical Center, Tufts University School of Medicine, Springfield, MA, USA
| | - Andrew R Doben
- Baystate Medical Center, Tufts University School of Medicine, Springfield, MA, USA
| | - Marvin E Morris
- Baystate Medical Center, Tufts University School of Medicine, Springfield, MA, USA
| | - Ronald I Gross
- Baystate Medical Center, Tufts University School of Medicine, Springfield, MA, USA
| | - Amanda Kravetz
- Baystate Medical Center, Tufts University School of Medicine, Springfield, MA, USA
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