case_images: PMC9054496_01
case_images: 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.
case_images: CRIVAM2022-3595603.001.jpg
case_images: PMC9054496_01_CRIVAM2022-3595603.001.jpg
case_images: fig1
case_images: This revealed a variant celiac-mesenteric trunk (CMT) with evidence of celiac trunk/SMA compression and intraluminal thrombus in the SMA (Figure 1).
case_images: 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.
case_images: CRIVAM2022-3595603.002.jpg
case_images: PMC9054496_01_CRIVAM2022-3595603.002.jpg
case_images: fig2
case_images: A Doppler ultrasound was performed, and this revealed cyclic angulation and compression of the celiac trunk on forced expiration, with expiratory dilatation (Figure 2).
case_images: 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.
case_images: CRIVAM2022-3595603.003.jpg
case_images: PMC9054496_01_CRIVAM2022-3595603.003.jpg
case_images: fig3
case_images: The left gastric artery was identified and traced retrograde to the CMT trunk (Figure 3).
case_images: 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).
case_images: CRIVAM2022-3595603.004.jpg
case_images: PMC9054496_01_CRIVAM2022-3595603.004.jpg
case_images: fig4
case_images: The MAL was divided until the ventral surface of the aorta was exposed for 5-6 cm (Figure 4).
case_images: 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.
case_images: CRIVAM2022-3595603.005.jpg
case_images: PMC9054496_01_CRIVAM2022-3595603.005.jpg
case_images: fig5
case_images: In order to confirm viability and perfusion of the anastomotic ends, we used fluorescence angiography with intravenous indocyanine green (Figure 5).
case_images: Follow-up CT scan at 8 months showing resolution of the thrombus in the superior mesenteric artery.
case_images: CRIVAM2022-3595603.006.jpg
case_images: PMC9054496_01_CRIVAM2022-3595603.006.jpg
case_images: fig6
case_images: 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.