Persistant Abdominal Pain: “Dissectiing” a Differential Diagnosis: 1072

Spontaneous visceral artery dissection is a rare event. Although there are identifiable risk factors, there is no particular mechanism that is common to vascular dissections. We present a case with Isolated Celiac Artery dissection; a rare entity. To our knowledge only few cases have been described. Endovascular treatment and/or surgical intervention is preferred for complicated cases, our patient who was stable, received conservative medical management. A sixty-six year old male with history of hepatitis C and forty pack year smoking history, presented with five days intermittent low back pain and epigastric tenderness. Symptoms started while shoveling snow in his driveway; back pain was described as “pressured” and 9/10 on pain scale. Concomitant epigastric pain was ‘sharp/knife-like', located in the left upper quadrant and radiated to the mid back. He denied vomiting, diarrhea, fevers, bright red blood per rectum, melena or rigors. No history of hypertension, peripheral vascular disease, or coronary disease. Vitals revealed blood pressure of 160/84, heart rate of 54. Complete blood count and basic metabolic panel, Lipase were unremarkable. CT without contrast revealed infiltration of the perivascular fat at the level of the celiac axis and superior mesenteric artery suspicious for mild inflammatory stranding associated with an arteritis. CT angiogram revealed antegrade intimal dissection of the celiac axis origin is present extending 3cm into the trunk. A 6mm flow channel was preserved before branching. Patient was treated with conservative medical management which included strict blood pressure control, anticoagulation, analgesics, and serial abdominal exams. The patient was discharged home without endovascular or surgical intervention, close follow up with primary care physician was recommended.Isolated Celiac Artery dissection is a rare entity and our literature review reveals few described cases. Improved accessibility to hospitals and advancement in radiographic modalities we anticipate an increased presentation in visceral artery dissection. Epigastric pain with concomitant low back pain carries a broad differential, in patients with non-specific clinical exam and unremarkable laboratory data; we encourage clinicians to be cognizant of visceral artery dissections while formulating their differential diagnosis. Computed Tomography together with vitals, labs, and physical examination can provide the diagnosis of visceral artery dissection which can help guide us with conservative or surgical interventions. Such practice can improve emergency to operating room transit time, defer other invasive tests, and optimize medical management.Figure 1Figure 2