Celiac Trunk Stenosis Treated by Resection and Splenic Patch Reconstruction – A Case Report and Literature Review

Abstract

Abstract. Celiac trunk stenosis is a relatively common finding; the most common causes of this obstructionCeliac trunk stenosis has been reported with an incidence ranging from 12.5-24% (1, 2). The main etiological factors consist of median arcuate ligament compression, followed by arteriosclerosis, pancreatitis, tumoral invasion or congenital abnormalities (3). Moreover, it seems that ethnicity strongly influences the cause of celiac axis stenosis: while in patients from Western countries the main cause is atherosclerosis, in Japanese study groups, the main cause is median arcuate ligament syndrome (1, 3, 4). According to Sakorafas et al., causes inducing celiac artery stenosis can be classified into three groups: extrinsic (mediate arcuate ligament syndrome, compression induced by the celiac ganglion or surrounding fibrotic transformations), intrinsic (due to arteriosclerosis) and other causes (including congenital malformations, acute or chronic disease, malignant invasion or compression due to chronic pancreatitis) (5).When it comes to the presence of associated symptoms, it is most often related to the degree of stenosis. With fewer than 1% of all abdominal arteriograms detecting severe stenosis, it seems that patients with celiac trunk stenosis remain asymptomatic for a long period of time, a reduction of the arterial blood flow by 60-75% being needed to become symptomatic (6-8). Another important fact which influences the presence of symptomatic disease is the existence of a collateral circulation via the superior mesenteric artery (3). It is estimated that patients presenting celiac artery stenosis will develop collateral circulation via the superior mesenteric artery to the hepatic, gastric and splenic branches (which in a normal patient would be directly supplied by the celiac trunk) (9, 10). In patients presenting chronic celiac artery stenosis, adequate collateral circulation develops in up to 80% of patients; however, in certain cases in which the collateral circulation is not well developed, for various reasons, symptoms might appear. Case ReportThe 51-year-old patient was initially investigated for diffuse postprandial abdominal pain and weight loss; by angiocomputed tomography he was diagnosed with 70% stenosis of the celiac trunk extending 8 mm in length due to an extrinsic compression induced by the median arcuate ligament (Figure 1). The patient was submitted to arcuate ligament resection. However, the symptoms reappeared 6 months later, therefore, another evaluation through angio- 699This article is freely accessible online.Correspondence to:

Unique multidisciplinary approach in a patient with small bowel obstruction and chronic mesenteric ischemia

“…SBO in the setting of chronic mesenteric ischemia is a rare occurrence and there is no clear clinical guideline on how to treat these cases. Further studies on the incidence of such cases are warranted as celiac axis stenosis is seen in up to 25% of patients [ 7 ]. It will be important to ascertain whether revascularization indeed leads to improved post-operative outcomes.…”

Distal Pancreatectomy En Bloc With Splenectomy, Celiac Axis and Portal Vein Resection Followed by Arterial Reconstruction Using a Cadaveric Graft – A Case Report and Literature Review

“…Due to the fact that pancreatic body tumors remain asymptomatic for a long period of time a significant number of cases will be diagnosed in advanced stages of the disease; therefore, these patients will be diagnosed after a long period of local evolution of the tumoral process that will lead to the apparition of vascular invasion of the surrounding structures (7,8). Although initially it has been considered that the presence of vascular invasion should be considered as a criterion of unresectable lesion, improvement of the surgical techniques led to a higher rate of association of vascular resections; in the meantime the benefit of survival also became evident (9)(10)(11)(12)(13)(14)(15). Therefore, patients submitted to standard pancreatic resections reported similar long-term outcomes when compared to cases submitted to pancreatic resections en bloc with portal vein resection.…”

Enigma of Bowel Angina: Unraveling Celiac Trunk Stenosis

“…Incidence ranges from 12.5-24% in Caucasians. According to Sakorafas et al, the etiology of celiac trunk stenosis is classified as intrinsic (due to atherosclerosis), extrinsic due to median arcuate ligament syndrome, and other causes like malignancy [ 1 ]. Diagnosis of the syndrome includes ultrasound, CT angiogram, multi-detector CT scanners, and magnetic resonance angiography along with suggestive clinical features.…”