Repair of inflammatory celiac artery aneurysm presenting with insidious onset of abdominal pain: A case report

Abstract

Background

Visceral artery aneurysms (VAAs) are rare but potentially devastating given the high mortality associated with rupture. Current Society of Vascular Surgery guidelines recommend repair of these at 2.5 cm. Surgical intervention includes endovascular embolization and/or stenting versus open revascularization. This case presents a patient with a large celiac artery aneurysm (CAA) who underwent open ligation of the celiac artery at the origin. Splenectomy was performed given the need for ligation of the splenic artery. He had a replaced right hepatic artery from the SMA; thus, no revascularization was needed. Ultimately, the aneurysm was found to be inflammatory in etiology.

Case report

A 41-year old male with history of seizure disorder, smoking, and newly diagnosed hypertension presented with abdominal pain for six months. His-laboratory work was significant for a leukocytosis of 17, 740, mildly elevated C- Reactive Protein (CRP) at 1.63, and normal erythrocyte sedimentation rate (ESR). CT angiogram revealed a 5.2 × 4.2 cm celiac artery aneurysm with stranding. Given its appearance and concern for infection, he underwent emergent laparotomy and ligation. Blood cultures and intraoperative tissues revealed no microorganism growth. Pathology was remarkable only for periarterial abscess with acute and chronic inflammation and focal tissue necrosis, compatible with aneurysm.

Conclusion

This case report presents a rare inflammatory CAA, which presented with six months of abdominal pain, and its subsequent management with open intervention. In this case, his vessel anatomy was favorable for open repair with ligation of the celiac axis due to the presence of a replaced right hepatic artery. This also highlights the importance of anatomic vessel variants when making surgical decisions.