Diagnostic and Surgical Implications of Non-occlusive Mesenteric Ischemic Ileus Associated With Common Celiacomesenteric Trunk: A Case Report and Literature Review

Abstract

The celiacomesenteric trunk (CMT), an exceedingly rare anatomic variant uniting the celiac artery and superior mesenteric artery (SMA), holds significant clinical and surgical implications. Despite its rarity, understanding these implications is crucial for effective management. This report outlines the case of a 99-year-old female presenting with septic shock and abdominal pain, with imaging revealing an incidental CMT. This paper aims to elucidate the surgical implications associated with CMT through a comprehensive case review and literature search. A 99-year-old female with multiple cardiovascular comorbidities presented with altered mental status and right lower quadrant abdominal pain. Upon arrival, the patient exhibited disorientation, an inability to follow commands, hypoxia, and hypotension. Significant laboratory findings included a white count of 20.6 x 10⁹/L, lactate of 6.1 mmol/L, glucose of 53 mg/dL, alanine transaminase (ALT)/aspartate aminotransferase (AST) of 186/336 U/L, and creatinine of 4.2 mg/dL. Immediate interventions involved high-flow oxygen, fluid resuscitation, intravenous antibiotics, and admission to the ICU for septic shock. A CT angiogram (CTA) revealed an incidental large common trunk comprising the celiac trunk and superior mesenteric artery (SMA). There was a high-grade stenosis at the origin of the SMA. However, all the vessels were widely patent distally, and acute mesenteric occlusion was ruled out. By day 12, the patient achieved clinical stability after conservative management and was discharged. Complications such as aneurysm, dissection, stenosis, thrombosis, or acute occlusion of a CMT may necessitate complex surgical interventions, including endovascular procedures or open hepatic surgery. Understanding these technical complexities is vital for avoiding surgical complications in critically ill patients.

Keywords: acute mesenteric ischemia; anatomic anomaly; aneurysm; celiacomesenteric trunk; celiomesenteric trunk; dissection; endovascular surgery; hepato-pancreato-biliary surgery; thrombosis.

Figure 1. The CTA shows the CA and the SMA arising from a common trunk (red arrow)

CTA: CT angiogram, CA: Celiac artery, SMA: Superior mesenteric artery

Figure 2. The red arrow depicts the SMA descending inferiorly directly from the common trunk

SMA: Superior mesenteric artery

Figure 3. This CTA image illustrates a high-grade stenosis (red arrow) at the branching point of the SMA

CTA: CT angiogram, SMA: Superior mesenteric artery

Figure 4. This coronal section displays the CHA (red arrow), LGA (blue arrow), and SMA (green arrow) originating from a common trunk

CHA: Common hepatic artery, LGA: Left gastric artery, SMA: Superior mesenteric artery