Acute occlusion of the celiac axis and its branches with perforation of gastric fundus and splenic infarction, findings on spiral computed tomography: a case report

Celiac Trunk Thrombosis a Rare Cause of Acute Abdomen. Case Presentation

Thrombosis of the celiac artery trunk is a rare cause of acute abdominal pain which is associated with high mortality and morbidity if not diagnosed and treated early. We present an unusual case of celiac trunk artery thrombosis associated with aortic thrombosis and partial splenic infarction in a 52-year-old female who presented with acute abdominal pain. Hematological investigations failed to predict any predisposing factors. This case demonstrates the importance of considering such clinical presentation in the differential diagnosis of acute abdomen

Coeliac artery and splenic artery thrombosis complicated with splenic infarction 7 days following the first dose of Oxford vaccination, causal relationship or coincidence?

The novel coronavirus SARS-CoV-2 became a global pandemic in late 2019, and is still ongoing in 2021 causing significant morbidity and mortality. The advent of vaccinations heralded the turning of the tide. The Oxford jab, a vector-based vaccine was favoured due to its low cost and ease of storage. However, its potential association with thromboembolic adverse events resulted in controversy and disrupted its roll-out and use. The aetiopathogenesis of these thromboembolic events and its association with the Oxford vaccine are still speculative and uncertain, more so in the background of SARS-CoV-2 infection being highly thrombogenic in its own right. This paper presents a case of an otherwise healthy 50-year-old Caucasian man who developed acute abdominal pain 7 days following the first dose of Oxford vaccine and was found to have coeliac and splenic artery thrombosis complicated with splenic infarction.

Clinics in diagnostic imaging (176). Acute embolic occlusion of the coeliac artery

A 52-year-old man, who had a background of chronic heart disease and atrial fibrillation, as well as non-compliance with warfarin therapy, presented with a two-week history of worsening upper abdominal pain. Computed tomography mesenteric angiography showed complete embolic occlusion of the coeliac artery with resultant segmental splenic infarction, and thrombus within the left ventricle. A decision was made to proceed with catheter-directed thrombolysis. Subsequent follow-up angiogram at 12 hours showed successful treatment with complete dissolution of the coeliac embolus. The patient's symptoms resolved during his hospitalisation and he was subsequently discharged well on long-term oral anticoagulation therapy. Isolated acute embolic occlusion of the coeliac axis is a rare occurrence that may result in end-organ infarction. Treatment options include systemic anti-coagulation, mechanical thrombectomy, catheter thrombolysis or open surgery. Catheter-directed thrombolysis therapy is a feasible and effective option for treating acute thromboembolic occlusion of the coeliac artery.

Ischemic Gastritis: A Multicenter Case Series of a Rare Clinical Entity and a Review of the Literature

GOALS

To report a case series of ischemic gastritis and discuss its etiology, management, and associated mortality according to our results and the published English literature.

BACKGROUND

Ischemic gastritis is rare, given the rich blood supply of the stomach. It has been reported in isolated case reports and small case series. Most cases are vascular in origin and associated with a high mortality.

STUDY

Pathology databases from 3 hospitals affiliated with the University of Minnesota Medical School were searched for cases of ischemic gastritis in the last 10 years. Patients' demographics, clinical course, and 1-month and 1-year mortalities were collected from electronic medical records.

RESULTS

A total of 12 patients were identified (age range, 32.1 to 83.2), the largest series reported to date. The presenting symptom was gastrointestinal bleeding (8), abdominal pain (2), nausea (1), and symptomatic anemia (1). The etiology included postinterventional radiology embolization (2), hemodynamic changes in the setting of celiac axis stenosis (2), vasculitis (1), systemic hypotension (1), and unknown (6). Treatment included steroid therapy, revascularization by interventional radiology, surgery, or supportive treatment. Thirty-day and 1-year mortalities were 33% and 41%, respectively.

CONCLUSIONS

Ischemic gastritis is rare, but associated with a high mortality. Evaluation for treatable etiologies should be sought and corrected if present.

Acute celiac trunk thrombosis revealed by biliary peritonitis

Acute thrombosis of the celiac trunk is a very uncommon condition, which is a life-threatening emergency. The clinical presentation is highly variable depending on the extent of the ischemic territory. We report a case of biliary peritonitis related to an acute thrombosis of the celiac trunk. This case highlights the role of abdominal computed tomography in the diagnosis of acute upper abdominal pain.