Coeliac trunk dissection causing splenic infarction: a comprehensive review

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.