Spontaneous dissection of celiacomesenteric trunk with isolated extension and thrombosis in the superior mesenteric artery: a case report and literature review

BackgroundCeliacomesenteric trunk (CMT) is one of the rare congenital anomalies of the splanchnic vasculature, characterized by the common trunk origin of the superior mesenteric artery (SMA) and celiac trunk from the abdominal aorta. Dissection of CMT with isolated SMA involvement without bowel ischemia has been rarely reported in the literature.Case presentationA 48-year-old male presented with generalized abdominal pain for 20 days, which increased after food intake. He also gave a history of passing loose stools on and off in the last 10-15 days, associated with melena for 4-5 days. Computed tomography (CT) and CT angiography (CTA) study of the abdomen demonstrated the common trunk origin of SMA and celiac trunk from the abdominal aorta at the D12-L1 disk level, consistent with the celiacomesenteric trunk (CMT). CTA also revealed dissection of CMT with isolated extension in the SMA origin and thrombosis in the mid and distal SMA. No bowel or mesenteric ischemia was seen due to extensive collateral supply to distal-most SMA and its branches, mainly through the inferior mesenteric artery (IMA) via an arc of Riolan and artery of Drummond. The patient was managed conservatively with bowel rest, anti-thrombolytics, and anticoagulant therapy based on imaging findings of short-segment dissection with no signs of bowel or mesenteric ischemia.ConclusionDiagnosis of rare vascular anomalies like CMT with associated complications of dissection and thrombosis is critical in patients with abdominal pain for prompt and precise management. CTA of the abdomen is essential for accurate diagnosis and characterization of the abnormality, which helps decide between conservative and surgical treatments.