PMC9054496_01
Sagittal view of a CT mesenteric angiogram showing a short celiac-mesenteric trunk (asterisk) arising from the abdominal aorta. The trunk further branches into the celiac trunk (CT) and superior mesenteric artery (SMA). Inset: an intraluminal thrombus can be seen within the SMA appearing as a filling defect (green arrow) and causing flow cessation in the lumen.
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fig1
This revealed a variant celiac-mesenteric trunk (CMT) with evidence of celiac trunk/SMA compression and intraluminal thrombus in the SMA (Figure 1).
Duplex Doppler ultrasound images demonstrating narrowing of the CMT during forced expiration and dilation in the inspiratory phase. A maximum expiratory peak systolic velocity of 374 cm/sec was recorded within the coeliac axis.
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A Doppler ultrasound was performed, and this revealed cyclic angulation and compression of the celiac trunk on forced expiration, with expiratory dilatation (Figure 2).
Intraoperative view showing that the left gastric artery (LGA) and common hepatic artery (CHA) have been dissected. The vessel will be encircled with loops and followed retrograde to the celiaco-mesenteric trunk.
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The left gastric artery was identified and traced retrograde to the CMT trunk (Figure 3).
Completed dissection reveals a 5 cm segment of the ventral abdominal aorta (AA). The short celiaco-mesenteric trunk (CMT) can be seen branching into the superior mesenteric artery (SMA) and celiac trunk (CT). The three branches of the celiac trunk can be traced: common hepatic artery (CHA), splenic artery (SPL), and left gastric artery (LGA). The fibers of the divided median arcuate ligament are also visible (arrows).
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The MAL was divided until the ventral surface of the aorta was exposed for 5-6 cm (Figure 4).
Intraoperative view of the laparoscopic feed. The strictured jejunal segment has been resected using an endo-GIA stapler (a). In order to confirm perfusion of the jejunal ends, ICG has been injected intravenously (b), and perfusion was confirmed.
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In order to confirm viability and perfusion of the anastomotic ends, we used fluorescence angiography with intravenous indocyanine green (Figure 5).
Follow-up CT scan at 8 months showing resolution of the thrombus in the superior mesenteric artery.
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A follow-up CT scan revealed complete resolution of the thrombus (Figure 6) and resolution of intra-abdominal findings, such as fat stranding and mural thickening.