Celiac 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 celiac 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 ischemic colitis. There was evidence of ischemia and infarction of the transverse colon to sigmoid colon, there was gross and biochemical evidence of pancreatic and hepatic ischemia. The patient underwent a total colectomy in two stages though has, to date, had no intervention for her celiac stenosis. Other organ ischemia improved with supportive care.
Interestingly the most obvious finding on this series is the celiac artery stenosis with ischemia of an area of gut not supplied by this vessel.