Visceral collateralization with symptomatic occlusion of celiomesenteric trunk.

Abstract

A 57-year-old woman presented with 5 years of progressive, severe postprandial abdominal pain. Endoscopic and ultrasound evaluations were unremarkable, and empirical treatment for peptic ulcer disease failed to relieve her symptoms. She had fear of eating, resulting in a 40-pound weight loss, and was self-medicating with narcotics and smoking for appetite suppression. Computed tomography angiography revealed occlusion of the proximal celiac axis and a common celiomesenteric trunk (CMT). The inferior mesenteric artery (IMA) was large at 6 mm, and the mesenteric arcadewasquite evident,measuringup to7.5mmindiameter in someareas (A/Cover, B). Surgical exploration confirmed the CMT and revealed a dense, avascular fibrous band compressing the origin of the celiac trunk, the median arcuate ligament. There were chronic fibrotic changes of the celiac artery, and it remained occluded with a poor Doppler signal after complete lysis of the band. Therefore, a 6-mm Dacron aortomesenteric bypass graft was performed to the confluence of branches originating from the CMT (C). Exploration of the remainder of the abdomen revealed a markedly hypertrophic marginal artery of Drummond throughout its course within the large bowel mesentery. Postoperatively, she became pain free with eating and began to regain weight. The patient’s consent for publication was obtained.

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