Aneurysm of the celiac artery arising from a celiomesenteric trunk

Abstract

A 36-year-old man was found to have asymptomatic aneurysms of the celiac artery during an incidental ultrasound. Three-dimensional computed tomography (3D-CT) revealed two saccular aneurysms at the origin of the celiac artery that originated from a common celiomesenteric trunk (CMT) with the superior mesenteric artery (SMA) (A, Cover). The common hepatic and splenic arteries originated from the celiac artery just distal to the aneurysms. The left gastric artery originated from the aorta. Surgical treatment was recommended, and the aneurysms were exposed just below the pancreas by division of the transverse mesocolon (B). After dissecting the CMT and the SMA, the aneurysms were resected at the origin of celiac artery. The celiac artery distal to the aneurysm resection was then anastomosed directly to the CMT where its origin had been excised. The histopathologic findings indicated medial necrosis. Postoperative 3D-CT showed a patent celiac artery (C). The patient’s postoperative course was complicated by severe diarrhea, which gradually resolved in a few months. Only seven cases of CMT aneurysm have been reported.1Kalra M. Panneton J.M. Hofer J.M. Andrews J.C. Aneurysm and stenosis of the celiomesenteric trunk a rare anomaly.J Vasc Surg. 2003; 37: 679-682Abstract Full Text Full Text PDF PubMed Scopus (19) Google Scholar, 2Ailawadi G. Cowles R.A. Stanley J.C. Eliason J.L. Williams D.M. Colletti L.M. et al.Common celiacomesenteric trunk aneurysmal and occlusive disease.J Vasc Surg. 2004; 40: 1040-1043Abstract Full Text Full Text PDF PubMed Scopus (38) Google Scholar Although all details of these reported patients are not described, they were between the ages of 46 and 52 years, so the patient in this report is the youngest. Arteriography has been the most common diagnostic examination, although 3D-CT was very useful for us in the preoperative planning for this rare condition. The patients reported in the literature were treated by aneurysmectomy and reconstruction by patch angioplasty in one patient, direct anastomosis in one, and bypass or interposition of prosthetic graft in three. Because our patient was young and the aneurysm was similar to case 2 in the report of Kalra et al,1Kalra M. Panneton J.M. Hofer J.M. Andrews J.C. Aneurysm and stenosis of the celiomesenteric trunk a rare anomaly.J Vasc Surg. 2003; 37: 679-682Abstract Full Text Full Text PDF PubMed Scopus (19) Google Scholar we adopted direct anastomosis, which was facilitated by complete dissection and mobilization of the CMT, SMA, and celiac artery. However, we believe that the patient suffered diarrhea because of injury of the celiac plexus, which may argue for more limited dissection. Further accumulation of patients with this rare disease is needed to demonstrate the best surgical procedure or catheter intervention. Treatment is usually recommended because of the propensity of these aneurysms to rupture.2Ailawadi G. Cowles R.A. Stanley J.C. Eliason J.L. Williams D.M. Colletti L.M. et al.Common celiacomesenteric trunk aneurysmal and occlusive disease.J Vasc Surg. 2004; 40: 1040-1043Abstract Full Text Full Text PDF PubMed Scopus (38) Google Scholar Download .gif (.04 MB) Help with files