Spontaneous dissection of the celiac trunk : a rare cause of abdominal pain - case report and review of the literature

Spontaneous dissection of the celiac trunk is uncommon and rarely considered in patients presenting with acute onset of epigas- tric pain. We report the case of a 48-year old male, diagnosed with a spontaneous dissection of the celiac trunk extending towards the common hepatic artery. He was treated conservatively and re- mained asymptomatic after two years of follow-up. Conservative treatment seems justified in the absence of bowel ischemia or signs of hemorrhage. Initial Computed Tomography angiography revealed the presence of a dissection with a pseudoaneurysm that remained stable and regressed towards a normal Computed Tomography angiography after 7 months of follow-up. Radiologic follow-up is warranted as progression of the dissection and/or total occlusion with or without symptoms can occur. The risk factors, the natural course and optimal treatment remain unclear due to the rarity of the disorder. Our patient had no predisposing cardio- vascular risk factors. Nevertheless, we observed a hypertrophic ligamentum arcuatum on Computed Tomography, possibly facili- tating the evolution towards a dissection. Next to the case report, we provide a review of the available literature. (Acta gastroenterol. belg., 2013, 76, 335-339).