An uncommon cause of abdominal pain following blunt abdominal trauma

Abstract

A 47-year-old otherwise healthy male presented to the emergency department 5 days after being involved in a motorcycle accident during which he hit his abdomen on the handlebars. The patient did not seek medical attention at the time of the accident. At the time of presentation to the emergency department, he was complaining of mild epigastric and left upper quadrant abdominal pain that was exacerbated by lying down, but had no relationship to eating. In addition, he was feeling increasingly distended, and was concerned that his stools were smaller in calibre and less frequent. The patient was experiencing mild nausea, but denied vomiting and had not been experiencing diarrhoea. He was afebrile and physical examination was remarkable only for mild tenderness to palpation in the epigastrium. Laboratory studies revealed an elevated lipase (166 U l 21 ). A contrast-enhanced CT scan of the patient's abdomen and pelvis was obtained (Figure 1). What are the significant findings? DiagnosisThe findings on the CT scan are compatible with intimal injury and focal thrombus involving the distal coeliac axis and proximal common hepatic and splenic arteries. No clear stigmata of pancreatic injury were evident on the CT scan, despite the mildly elevated lipase. There was no evidence of bowel ischaemia. The patient was seen by the vascular surgery team, who recommended conservative management given that there were no signs or symptoms of mesenteric malperfusion. He was started on daily oral aspirin 81 mg in the hope that the coeliac artery would recanalise, and the plan was for follow-up with the vascular surgery service. The patient was discharged and subsequently lost to follow-up.

Diagnosis and treatment of isolated celiac artery dissection following blunt trauma: A case report

“…In this case, the patient was asymptomatic; however, owing to the injury mechanism of being pulled by a car, a CT scan was performed. The use of contrast-enhanced CT in most cases revealed luminal filling defects, intimal flap, and surrounding hematoma diagnostic of traumatic CA dissection [9] . Although angiography is useful for evaluating collateral flow distal to the occlusion, CT is considered superior to angiography for CA dissection diagnosis as it provides superior image resolution and is less invasive.…”

“…We identified 8 previous reports on CA dissection after blunt abdominal trauma [3] , [4] , [5] , [6] , [7] , [8] , [9] , [10] (9 cases in total), the features of which are summarized and compared with the present case in Table 1 . All patients were male, with a mean age of 44.4 years.…”

Isolated Dissection of the Celiac Artery after Blunt Trauma: A Case Report and Review of Literature

“…Isolated CA injury, which is an injury to the CA without concomitant aortic injury, is the least common among all abdominal arterial injuries. To date, only 8 reports of isolated CA injury following blunt trauma have been reported [2][3][4][5][6][7][8][9]. These cases, except for 1 case without a detailed description, are summarized, along with our two cases, in Table 1.…”