(162) Spontaneous Isolated Celiac Artery Dissection Following Cocaine Use

Introduction: Spontaneous isolated celiac artery dissection (SICAD) without aortic dissection is a rare clinical phenomenon that can be life-threatening. SICAD typically presents with sudden onset abdominal pain and is most commonly observed in middle-aged men. The first reported case of spontaneous celiac artery dissection was described in 1959. Since 1959, there have been fewer than 200 reported cases of SICAD in the literature [1].

Description: A 57-year-old African-American male with hypertension and cocaine use presented with severe abdominal pain 30 minutes after cocaine use. Pain radiated to the periumbilical, epigastric, lower chest, and flanks. He was non-compliant with antihypertensives. The exam showed elevated blood pressure (160/106 mmHg, rising to 222/110 mmHg) but a soft, non-tender abdomen. Labs revealed elevated lactic acid; normal liver function and troponin. Toxicology was positive for cocaine and fentanyl. CTA showed celiac artery dissection extending into common hepatic and proximal left gastric arteries. Initial treatment included Nicardipine, opioids, Heparin, Aspirin, Atorvastatin, and later Plavix. The patient was discharged stable on dual antiplatelet therapy, Atorvastatin, Amlodipine, and Losartan, with vascular surgery follow-up planned.

Discussion: Spontaneous isolated celiac artery dissection (SICAD) typically presents with sudden abdominal pain and is associated with hypertension, atherosclerosis, and smoking [2,3]. While not directly linked, cocaine use may potentially contribute due to its cardiovascular effects. SICAD shows male predominance (6:1 ratio) with median ages of 50.5 for men and 53.9 for women. Abdominal pain, especially epigastric, is the main symptom (83.54%) [4]. CT angiography is crucial for diagnosis. Treatment approaches include conservative management, antithrombotic therapy, and surgical/endovascular interventions [5-7]. Conservative management shows high symptom improvement rates (92.45-96.58%) [4]. Surgery is considered for complications like rupture or organ ischemia. While traumatic dissections may require urgent intervention, SICAD treatment protocol remains uncertain due to limited clinical data.