case_images: PMC8008131_01
case_images: A 65-year-old man with atraumatic acute abdominal pain and vomiting: Arterial phase contrast enhanced computed tomography of the abdomen in the axial (a), coronal (b) and sagittal planes (c) show a well-orgnised mesenteric haematoma (asterix, a) of approximately 9 cm. Two small aneurysms were identified (arrows, b) originating from the upper and lower pancreatico-duodenal arteries. There was significant coeliac artery compression by the median arcuate ligament (arrow, c) resulting in post-stenotic fusiform dilatation of the celiac artery. Non-enhanced computed tomography in the axial plan (d), performed 2 months later, shows homogeous liquifecation of the haematoma with a well-distinguished regular and thin wall.
case_images: SAJR-25-1993-g001.jpg
case_images: PMC8008131_01_SAJR-25-1993-g001.jpg
case_images: F0001
case_images: There was marked CA compression by the MAL resulting in post-stenotic fusiform dilatation of the CA (Figure 1).
case_images: PMC8008131_02
case_images: A 64-year-old woman with persistent diffuse abdominal pain, admitted for haematemesis and melena. Axial non-enhanced computed tomography demonstrates a homogeneous hyperdense haematoma of approximately 14 cm (a), haemorrhage within the stomach (arrow, b) and haemoperitoneum (arrow, c). Arterial phase sagittal reconstruction (d) demonstrates moderate coeliac artery compression by the median arcuate ligament with no visible pancreatico-duodenal artery aneurysms.
case_images: SAJR-25-1993-g002.jpg
case_images: PMC8008131_02_SAJR-25-1993-g002.jpg
case_images: F0002
case_images: There was moderate CA compression by the MAL with no visible PDA aneurysm (Figure 2).
case_images: PMC8008131_03
case_images: A 44-year-old woman admitted with haematemesis and melena. Non-enhanced computed tomography in the axial plane (a) showing a homogeneous hyperdense haematoma of approximately 11 cm. Arterial phase in coronal (b), sagittal (c), axial (d) and oblique plan (e) revealed a small aneurysm (arrow, b) originating from the inferior pancreatic-duodenal artery (IPDA) (arrow, b); Moderate coeliac artery compression by the median arcuate ligament (arrow, c) is identified. There is a Standford B aortic dissection (e) where the coeliac artery originantes from the false lumen (d).
case_images: SAJR-25-1993-g003.jpg
case_images: PMC8008131_03_SAJR-25-1993-g003.jpg
case_images: F0003
case_images: It is postulated that the above scenario was caused by the decreased blood flow in the CA compressed by the intimal flap (causing dynamic ischaemia), which then resulted in further decreased flow in the coeliac trunk, increased blood flow in SMA branches and finally rupture of the pre-existing aneurysm (Figure 3).