The celiacomesenteric trunk (CMT), an exceedingly rare anatomic variant uniting the celiac artery and superior mesenteric artery (SMA), holds significant clinical and surgical implications. Despite its rarity, understanding these implications is crucial for effective management. This report outlines the case of a 99-year-old female presenting with
septic shock and
abdominal pain, with imaging revealing an incidental CMT. This paper aims to elucidate the surgical implications associated with CMT through a comprehensive case review and literature search. A 99-year-old female with multiple cardiovascular comorbidities presented with altered mental status and right lower quadrant
abdominal pain. Upon arrival, the patient exhibited disorientation, an inability to follow commands,
hypoxia, and
hypotension. Significant laboratory findings included a white count of 20.6 x 109/L,
lactate of 6.1 mmol/
L, glucose of 53 mg/dL,
alanine transaminase (ALT)/
aspartate aminotransferase (AST) of 186/336 U/L, and
creatinine of 4.2 mg/dL. Immediate interventions involved high-flow
oxygen, fluid
resuscitation, intravenous
antibiotics, and admission to the ICU for
septic shock. A CT angiogram (CTA) revealed an incidental large common trunk comprising the celiac trunk and superior mesenteric artery (SMA). There was a high-grade
stenosis at the origin of the SMA. However, all the vessels were widely patent distally, and acute mesenteric occlusion was ruled out. By day 12, the patient achieved clinical stability after
conservative management and was discharged. Complications such as
aneurysm, dissection,
stenosis,
thrombosis, or acute occlusion of a CMT may necessitate complex surgical interventions, including
endovascular procedures or open hepatic surgery. Understanding these technical complexities is vital for avoiding surgical complications in
critically ill patients.