Published online Dec 6, 2020. doi: 10.12998/wjcc.v8.i23.6164
Peer-review started: July 22, 2020
First decision: September 24, 2020
Revised: September 27, 2020
Accepted: October 20, 2020
Article in press: October 20, 2020
Published online: December 6, 2020
Processing time: 134 Days and 21.9 Hours
Acute celiac artery (CA) injuries are extremely rare but potentially life-threatening and are more often caused by a penetrating injury rather than a blunt injury. The clinical manifestation of CA injuries is usually atypical, which easily causes missed diagnosis and misdiagnosis. Currently, there are only a few reports of acute traumatic occlusion of CA. The CA artery gives off branches to dominate the liver, stomach. and spleen; however, occluded CA did not cause significant organ ischemia, and the compensatory blood flow from the superior mesenteric artery (SMA) played a pivotal role.
Herein, we report two cases of acute CA occlusion secondary to severe blunt trauma. Case one was a 19-year-old male, suffered from a motorcycle crash. He complained of dyspnea, and the closed drainage was performed soon after the hemopneumothorax was confirmed by ultrasound. Computed tomography (CT) scan revealed hemopneumothorax, multiple rib fractures, right scapular fracture, and liver rupture. Reexamination with contrast-enhanced CT suggested perihepatic fluid was significantly increased, and CA was occluded. Because the hepatic hemorrhage is associated with hepatic artery injury, the CA was retrogradely opened through the SMA, and then, the right hepatic artery was embolized with coils successfully through the conventional pathway. Stent implantation was not performed, and the CA occlusion was managed by conservative treatment. A follow-up CT scan 3 mo after discharge showed the origin of CA remained occluded. Case two was a 37-year-old man, suffered injury from fall from height. He complained of lower back and bilateral heel pain. Contrast-enhanced CT examination revealed multiple rib fractures, bilateral pneumothorax, fourth lumbar (L4) vertebral burst fracture, and pelvic fractures. Furthermore, a small high-density mass in a lesser peritoneal sac and in front of the abdominal aorta was detected. The reexamination 14 h after admission showed the CA was occluded. The patient was conservatively treated. The symptoms of nausea after meals disappeared about 4 wk later, and abdominal distension was significantly relieved after 6 wk. The abdominal CT angiography at 60 d showed that the CA thrombus was not recanalized.
Patients with CA occlusion will have different clinical manifestations, and the dominant organ will not have obvious ischemia. Conservative treatment is safe, and the patient’s symptoms will be improved with the establishment of collateral circulation.
Core Tip: We present two cases of acute blunt celiac artery (CA) occlusion. Two patients showed significant differences after CA occlusion. The first patient had clinically evident bleeding from the hepatic artery after liver trauma, while the second patient had obvious gastrointestinal symptoms. Although CA occlusion is extremely rare, our continuous management of two such patients within a week suggests that the incidence of the disease may be underestimated. Early use of enhanced computed tomography examination can help increase the detection rate of CA injury. Due to the establishment of collateral circulation, CA occlusion will not cause obvious organ ischemia, and conservative treatment is safe.