Case Report of Extensive Isolated Spontaneous Celiac Trunk Dissection After Liver Transplantation

Area of Science:

• Vascular Surgery
• Hepatobiliary Surgery
• Transplant Surgery

Background:

• Arterial dissection is an infrequent complication following liver transplantation (LT).
• Isolated spontaneous celiac trunk dissection (ISCTD) is a rare vascular event, typically managed conservatively.
• This case explores ISCTD in the context of living donor liver transplantation (LDLT).

Observation:

• A 48-year-old female recipient of LDLT developed ISCTD extending to the proper hepatic, left gastric, and splenic arteries.
• Postoperative Doppler ultrasound initially showed adequate hepatic artery flow, but a reduction was noted on postoperative day 10.
• Contrast-enhanced CT confirmed extensive ISCTD with an intimal tear at the celiac trunk's origin, indicating partial liver ischemia.

Findings:

• Conservative management with antiplatelet agents was initiated due to thrombosed false lumens and normalized liver enzymes.
• The patient achieved a successful outcome, with normalized liver function and patent hepatic artery at 18-month follow-up.
• Imaging demonstrated significant reduction in the false lumens of the dissected arteries.

Implications:

• Conservative therapy is a viable and potentially first-line treatment for ISCTD, even in the post-liver transplantation setting.
• This approach can lead to favorable long-term outcomes, including restoration of arterial patency and preserved liver function.
• The findings support a less invasive management strategy for ISCTD, challenging the need for immediate surgical intervention in select cases.