Coeliac artery severe stenosis and dissection
Acute left sided abdominal pain and shock.
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Long segment of colonic wall thickening from mid transverse to mid sigmoid colon with associated fat stranding. There is a severe proximal coeliac artery stenosis and a focal dissection flap at the posterior aorta at the level of the SMA origin.
The patient underwent a laparotomy which confirmed the diagnosis of ischaemic colitis. There was evidence of ischaemia and infarction of the transverse colon to sigmoid colon, there was gross and biochemical evidence of pancreatic and hepatic ischaemia. The patient underwent a total colectomy in two stages though has, to date, had no intervention for her coeliac stenosis. Other organ ischaemia improved with supportive care.
Interestingly the most obvious finding on this series is the coeliac artery stenosis with ischaemia of an area of gut not supplied by this vessel.