+ Site Statistics
+ Search Articles
+ PDF Full Text Service
How our service works
Request PDF Full Text
+ Follow Us
Follow on Facebook
Follow on Twitter
Follow on LinkedIn
+ Subscribe to Site Feeds
Most Shared
PDF Full Text
+ Translate
+ Recently Requested

A major pain in the … Back and epigastrium: an unusual case of spontaneous celiac artery dissection



A major pain in the … Back and epigastrium: an unusual case of spontaneous celiac artery dissection



Journal of Community Hospital Internal Medicine Perspectives 4(5): 23840



A 60-year-old woman with mitral valve prolapse, chronic low back pain, and a 30-pack year smoking history presented for a second admission of poorly controlled mid-back pain 10 days after her first admission. She had concomitant epigastric pain, sharp/burning in quality, radiating to the right side and to the mid-back, not associated with food nor improving with pain medications. She denied nausea, vomiting, diarrhea, constipation, dark stools, or blood per rectum. Our purpose was to determine the cause of the patient's epigastric pain. Physical examination revealed epigastric and mid-back tenderness on palpation. Labs were normal except for a hemoglobin drop from 14 to 12.1 g/dL over 2 days. Abdominal ultrasound and subsequent esophagogastroduodenoscopy were normal. Contrast-enhanced abdominal computed tomographic (CT) scan revealed the development of a spontaneous celiac artery dissection as the cause of the epigastric pain. The patient was observed without stenting and subsequent CT angiography 4 days later did not reveal worsening of the dissection. She was discharged on aspirin and clopidogrel with outpatient follow-up. Thus far, less than 100 cases of isolated spontaneous celiac artery dissections have been reported. The advent of CT scans and magnetic resonance imaging has increasingly enabled its detection. Risk factors may include hypertension, arteriosclerosis, smoking, and cystic medial necrosis. There is a 5:1 male to female ratio with an average presenting age of 55. Management of dissections may include surgical repair, endovascular stenting, and selective embolization. Limited dissections can be managed conservatively with anti-platelet and/or anticoagulation agents and strict blood pressure control, as done in our patient.

Please choose payment method:






(PDF emailed within 0-6 h: $19.90)

Accession: 057068556

Download citation: RISBibTeXText

PMID: 25432642

DOI: 10.3402/jchimp.v4.23840


Related references

Epigastric and chest pain in celiac artery dissection: spontaneous isolated dissection of the celiac trunk. European Heart Journal Cardiovascular Imaging 17(3): 315, 2016

A rare cause of epigastric pain: isolated spontaneous dissection of the celiac artery, a case report. Journal des Maladies Vasculaires 34(4): 275-278, 2009

Unusual presentation and treatment of spontaneous celiac artery dissection. Journal of Vascular Surgery 58(2): 491-495, 2013

Spontaneous celiac artery dissection: a rare vascular cause of abdominal pain. Anz Journal of Surgery 87(12): E342-E343, 2017

Spontaneous dissection of the celiac artery: a case report. Journal of Vascular Surgery 45(6): 1256-1258, 2007

Spontaneous dissection of the celiac artery: a pitfall in the diagnosis of acute abdominal pain. Presentation of two cases. Digestive Diseases and Sciences 49(7-8): 1223-1227, 2004

Spontaneous dissection of the celiac artery: a case report and literature review. American Journal of Emergency Medicine 31(6): 1000.E3-5, 2013

Spontaneous celiac artery dissection case report and literature review. Texas Heart Institute Journal 39(5): 703-706, 2012

Spontaneous superior mesenteric artery (SMA) dissection: an unusual cause of abdominal pain. Journal of Emergency Medicine 39(5): 576-578, 2010

Medical management of spontaneous celiac artery dissection: case report and literature review. Vascular and Endovascular Surgery 42(1): 62-64, 2008

Spontaneous dissection of the celiac trunk: a rare cause of abdominal pain--case report and review of the literature. Acta Gastro-Enterologica Belgica 76(3): 335-339, 2013

Isolated, spontaneous superior mesenteric and celiac artery dissection: case report and review of literature. Journal of Emergency Medicine 40(2): E21-E25, 2011

Spontaneous isolated dissection of the celiac trunk with rupture of the proximal splenic artery: a case report. European Journal of Vascular and Endovascular Surgery 37(2): 194-197, 2009

Unusual cause of acute back pain mimicking aortic dissection: a case report. Thoracic and Cardiovascular Surgeon 60(Suppl. 2): E28-E30, 2013

Spontaneous dissection of celiac trunk with concurrent splenic artery dissection. Clinical and Experimental Emergency Medicine 2(4): 256-259, 2015