1. A RARE CASE OF CELIAC AXIS ANEURYSM Abstract number: 108

2. 74 year old male Complaints of Passing dark colored stools – 5 days Endoscopy showed 1 ) Oesophageal venous bleb 2) Antral erosion PATIENT HISTORY

3. 1 ) History of slip and fall, 5 months back, fracture right neck of femur – underwent right hemiarthroplasty 2) 10 months back he was operated for left inguinal hernia (hernioplasty) Not a known case of Tuberculosis, diabetes mellitus, hypertension, bronchial asthma. On physical examination patient was found to have 1) Kyphosis and scoliosis 2) Small umbilical hernia PAST HISTORY

4. SCANOGRAM Scanogram shows right hip prosthesis and scoliosis towards right.

5. CT AXIAL PLAIN

7. AXIAL SECTIONS CONTRAST

9. CT CORONAL CONTRAST

10. CT SAGITTAL CONTRAST

11. Fusiform aneurysm measuring 6.5 x 5.9 cm with mural thrombus seen involving celiac axis and its bifurcation. Common hepatic artery and splenic artery seen originating from the aneurysm with ~ 60 – 80 % narrowing of the proximal portion of splenic artery. Multiple diverticuli seen in the ascending colon, hepatic flexure, transverse colon, splenic flexure, descending and sigmoid colon. Patient refused surgery and was managed conservatively. FINDINGS

12. Causes of celiac artery aneurysm - Atherosclerosis - Trauma - Surgery - Collagen vascular disease - Congenital anomalies However in 40% of cases cause is unknown DISCUSSION

13. Celiac artery aneurysms are one of the rarest forms of splanchnic artery aneurysm. Anomaly was first described in 1745, fewer than 180 cases have been reported in the international medical literature The reported incidence of rupture of celiac aneurysms is approximately 15-20%. Elective treatment should be considered in patients with aneurysms greater than 2 cm. DISCUSSION

14. Variety of treatments had been recommended such as surgical repair, graft and stent placement, endovascular embolization by coils, vascular plugs or glue. DISCUSSION

15. Interventional Repair - This minimally invasive technique is performed by using imaging to guide the catheter and graft inside the patient's artery. For the procedure, an incision is made in the skin at the groin through which a catheter is passed into the femoral artery and directed to the aneurysm. Through the catheter, a stent graft that is compressed into a small diameter within the catheter. The stent graft is advanced to the aneurysm, then opened, creating new walls in the blood vessel through which blood flows. DISCUSSION

16. SELDINGER NEEDLE DISCUSSION

17. Benefits of Interventional Repair: No abdominal surgical incision No sutures or sutures only at the groins Faster recovery, shorter time in the hospital No general anesthesia in some cases Less pain Reduced complications Disadvantages of Interventional Repair: Possible movement of the graft after treatment, with blood flow into the aneurysm and resumption of risk of growth/rupture of the aneurysm Probable life-time requirement for follow-up studies to be sure the stent graft is continuing to function

18. 1.Garcia de la Torre A, Lozano P, Corominas C, Julia J, Blanes I, Flores D, Manuel-Rimbau E. Aneurysm of the celiac trunk associated with infrarenal aortic and popliteal artery aneurysm [in Spanish]. Rev Esp Enferm Dig 1994;85:131–5 2.Shanley CJ, Shah NL, Messina LM. Common splanchnic artery aneurysms: splenic, hepatic, and celiac. Ann Vasc Surg 1996;10:315–22. 3.Kimura H, Sato O, Miyata T, Koyama H, Sugawara Y, Takagi A. Bleeding gastric varices as a result of splenic vein compression by a celiac arterial aneurysm. Surgery 1996;120:10610. 4.Bret PM, Partensky C, Paliard P, Delaye J, Bretagnolle M. Dissecting aneurysm of the celiac trunk and the hepatic artery [in French]. Presse Med 1985;14:698 REFERENCE

19. 5. Messina LM, Shanley CJ. Visceral artery aneurysms. Surg Clin North Am 1997;77:425-42. 6. Knox R, Steinthorsson G, Sumpio B. Celiac artery aneurysms: A case report and review of the literature. Int J Angiol 2000;9:99- 102. 7. Veraldi GF, Dorrucci V, de Manzoni G, Guglielmi A, Laterza E, Rombola G, et al. Aneurysm of the celiac trunk: Diagnosis with US-color-Doppler. Presentation of a new case and review of the literature. Hepatogastroenterology 1999;46:781-3. REFERENCE