CELIAC TERRITORY ISCHEMIC SYNDROME IN VISCERAL ARTERY-OCCLUSION

Abdominal angina that is characterized by postprandial pain, and often associated with weight loss, is a well-recognized symptom complex of mesenteric artery insufficiency (mesenteric territory symptoms). In th e past 5 years, we have observed six patients with atypical symptoms w ho had mesenteric artery occlusion combined with stenosis or occlusion of the celiac artery. Atypical symptoms included severe nausea and vo miting at the sight or smell of food, anorexia, weight loss, and right upper quadrant or epigastric discomfort (celiac territory symptoms). An extensive work-up to rule out gastric, pancreatic, biliary, or colo nic pathology was undertaken in these patients. The findings included gallbladder dysfunction, diffuse micro-ulceration of gastric mucosa, a nd colonic mucosal ulceration. The diagnosis of visceral artery occlus ion was initially missed in all six patients. Four patients had cholec ystectomy. Visceral angiography confirmed occlusion of the celiac, sup erior, and inferior mesenteric arteries. Five patients had dramatic re solution of symptoms after restoration of visceral circulation. One pa tient who developed intestinal infarction before revascularization die d. Symptoms suggesting upper abdominal visceral pathology may be a man ifestation of celiac artery stenosis/occlusion coexisting with mesente ric artery occlusive disease. Visceral angiography should be part of t he work-up in these patients for early diagnosis and prompt management .