Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Case Reports
. 2023 Aug 16:10:1240853.
doi: 10.3389/fcvm.2023.1240853. eCollection 2023.

Case report: Isolated dissection of the left gastric artery: an unusual cause of acute abdominal pain

V Frey  1 , R P Engelberger  1 , E Psathas  2
Affiliations
Case Reports

Case report: Isolated dissection of the left gastric artery: an unusual cause of acute abdominal pain

V Frey et al. Front Cardiovasc Med. .

Abstract

Spontaneous and isolated dissection of the left gastric artery is a rare occurrence, with only a handful of cases reported in the medical literature. Clinical presentation may mimic more common intra-abdominal pathologies; however, it is imperative to identify this condition promptly due to its potential serious consequences. This underscores the importance of maintaining a high level of clinical suspicion and including this pathology in the differential diagnosis of patients presenting with acute abdominal symptoms. Hence, this case report aims to increase awareness among clinicians about the importance of identifying and treating this rare condition promptly. A 69-year-old female experienced severe epigastric pain while attending a yoga class, prompting her admission to the emergency department 24 h later due to the persistence of her symptoms. Following imaging work-up utilizing computed tomography angiography (CTA), she was diagnosed with a dissection of the left gastric artery. Notably, there was no associated aneurysm or any evidence of ischemia in the esophageal or gastric wall. Conservative management, including low-dose aspirin and blood pressure control, was implemented. After 6 months of follow-up, CTA demonstrated expansion of the true lumen and the absence of secondary aneurysm formation, leading to discontinuation of aspirin. The management of spontaneous dissection of visceral arteries is primarily determined by the presence of complications and organ ischemia. In the case of uncomplicated visceral artery dissections, first-line treatment comprises surveillance and antiaggregation. Nevertheless, the optimal duration of antiplatelet therapy and the necessity for long-term follow-up remain unclear. Endovascular or surgical interventions should be reserved for patients exhibiting deteriorating symptoms or complications, and the decision to pursue these interventions should be made on a case-by-case basis.

Keywords: conservative treatment; contrast-enhanced computed tomography; left gastric artery dissection; sudden epigastric pain; visceral artery dissection.

PubMed Disclaimer

Conflict of interest statement

The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

Figures

Figure 1
Figure 1
Helicoidal 512 slice computed tomography angiography in arterial phase with 1.3 mm slices. (A) Sagittal view showing eccentric wall thickening of the LGA (arrow) from its start of the coeliac artery, evoking a dissection. (B) Coronal view of LGA dissection showing a diffuse irregular luminal narrowing (arrow). LGA, left gastric artery. (C) Normal perfusion of gastric wall (red mark), liver (blue mark) and spleen (yellow mark) in portal phase. (D) 3D-reconstruction of the celiac trunk anatomy (right lateral view, 90°).
Figure 2
Figure 2
Helicoidal 512 slice computed tomography angiography at 6 months in arterial phase with 1.3 mm slices. (A) Sagittal view of a less-thickened LGA (arrow) with near complete resolution of dissection. (B) Coronal view with a recanalization of the lumen of the LGA (arrow). LGA, left gastric artery.
Figure 3
Figure 3
Proposed algorithm for treatment of isolated splanchnic artery dissection.
See this image and copyright information in PMC

Similar articles

See all similar articles

References

    1. Yoshimi S, Tatsuya K, Kotani T, Sakiko H, Kuniyasu H, Shigeyuki M, et al. Isolated spontaneous dissection of the splanchnic arteries in the era of multidetector computed tomography. Matsushita MJ. (2015) 54:79–85.
    1. Jung SC, Lee W, Park EA, Jae HJ, Chung JW, Park JH. Spontaneous dissection of the splanchnic arteries: CT findings, treatment, and outcome. AJR Am J Roentgenol. (2013) 200(1):219–25. 10.2214/AJR.11.7877 - DOI - PubMed
    1. Zhu Y, Peng Y, Xu M, Wei Y, Wu S, Guo W, et al. Treatment strategies and outcomes of symptomatic spontaneous isolated superior mesenteric artery dissection: a systematic review and meta-analysis. J Endovasc Ther. (2018) 25(5):640–8. 10.1177/1526602818796537 - DOI - PubMed
    1. Ko SH, Hye R, Frankel DA. Management of spontaneous isolated visceral artery dissection. Ann Vasc Surg. (2015) 29(3):470–4. 10.1016/j.avsg.2014.10.026 - DOI - PubMed
    1. Kwon LM, Ha HI, Kim MJ, Lee K. A case of spontaneous isolated dissection of left gastric artery. J Korean Med Sci. (2016) 31(9):1349–50. 10.3346/jkms.2016.31.9.1349 - DOI - PMC - PubMed

Publication types

LinkOut - more resources