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Coeliac trunk dissection causing splenic infarction: a comprehensive review.

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A spontaneous coeliac trunk dissection caused splenic infarct in a 49-year-old man. This case highlights the importance of considering rare vascular events in abdominal pain diagnosis and management.

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Area of Science:

  • Vascular Surgery
  • Gastroenterology
  • Radiology

Background:

  • Spontaneous coeliac trunk dissection is a rare vascular emergency.
  • Splenic infarct can be a complication of coeliac trunk dissection.
  • Abdominal pain is a common presenting symptom, but atypical presentations exist.

Observation:

  • A 49-year-old man presented with acute epigastric pain radiating to the right shoulder after physical exertion.
  • CT angiography revealed dissection of the coeliac trunk extending into the splenic artery, causing splenic infarct.
  • Initial anticoagulation was complicated by retroperitoneal hemorrhage.

Findings:

  • The patient was managed conservatively with aspirin for secondary prevention.
  • Review of literature identified other cases of splenic infarct secondary to spontaneous coeliac trunk dissection.
  • Outcomes varied depending on the extent of dissection and management strategies.

Implications:

  • This case underscores the need for high clinical suspicion for visceral artery dissection in patients with unexplained abdominal pain.
  • Early diagnosis via CT angiography is crucial for appropriate management.
  • Conservative management with antiplatelet therapy may be a viable option in select cases of splenic infarct due to coeliac trunk dissection.