Spontaneous Isolated Symptomatic Celiac Artery Dissection: A Case Report

The celiac artery, also known as the celiac trunk, originates from the abdominal aorta at the level of the 12th thoracic vertebra. Arising from the anterior aorta, this ultrashort artery plays an integral role in supplying blood to the stomach, liver, spleen, pancreas, and proximal duodenum. Arterial dissection is a life-threatening emergency most frequently reported in the aorta, while visceral arterial dissections remain uncommon or may be undetected. A dissection involves a tear in the artery wall, which can lead to serious complications, including compromised arterial supply, end-organ ischemia, and rupture. Spontaneous dissection of the celiac artery is a rare vascular disease. Most patients are asymptomatic and incidentally diagnosed on abdominal imaging, but can present as acute abdominal pain. A dissection of the celiac trunk could potentially lead to a disruption in the perfusion of the pancreas, liver, and stomach with subsequent development of ischemia, inflammation, and infarction. This is, however, an uncommon event and has been described only in very few cases in the past. Our case describes this uncommon presentation, a patient with features of pancreatitis and hepatitis in the setting of a celiac artery dissection, likely related to ischemia. The diagnosis of celiac artery dissection relies on computerized tomography (CT) with contrast, preferably with angiography. Medical management, endovascular therapy with stents and rarely surgical reconstruction, or bypass could be employed for treating symptomatic patients. Ironically, endovascular treatment for cardiac and vascular diseases has emerged as a frequent culprit in the causation of arterial dissection: iatrogenic arterial dissection.