Yaygın Semptomlarla Başvuran Spontan Hepatik Arter Diseksiyonu: Tanıda Zorluk Yaratan Nadir Bir Klinik Durum

Yıl 2025, Cilt: 16 Sayı: 3, 122 - 125, 30.09.2025

Yiğit Kurnaz , Mustafa Selçuk Ayar , Merve Sarı , Aleyna Özcan , Ahmet Baydın

https://izlik.org/JA69RS58ES

Öz

ÖZET
Giriş: Spontan hepatik arter diseksiyonu, izole visseral arter diseksiyonlarının (IVAD) son derece nadir bir alt tipidir ve genellikle spesifik olmayan karın ağrısıyla seyrettiğinden erken tanı konulmasını güçleştirir. Ancak geç tanı, iskemi veya rüptür gibi yaşamı tehdit eden komplikasyonlara yol açabileceğinden, zamanında tanı büyük önem taşır.
Olgu Sunumu: Öyküsünde sistemik hastalığı olmayan 44 yaşındaki erkek hasta, yemek sonrası artan ve sırta yayılan sağ üst kadran ağrısı ile başvurdu. Fizik muayene ve laboratuvar tetkikleri dâhil ilk değerlendirmede anlamlı bir patoloji saptanmadı. Klinik şüphenin devam etmesi üzerine yapılan kontrastlı BT anjiyografide, hepatik arterde uzun segmentli diseksiyon, ileri düzey lümen daralması ve intralüminal trombüs izlendi. Karaciğer perfüzyonu korunmuştu ve iskemiye dair laboratuvar ya da radyolojik bulgu yoktu. Multidisipliner değerlendirme sonucunda, antikoagülasyon ve seri Doppler ultrasonografi ile konservatif izlem kararı alındı. Hasta komplikasyonsuz şekilde stabilize edildi.
Sonuç: Bu olgu, açıklanamayan karın ağrısında hepatik arter diseksiyonu olasılığının da göz önünde bulundurulması gerektiğini vurgulamaktadır. Organ perfüzyonu korunmuş ve hemodinamik olarak stabil hastalarda konservatif tedavi, güvenli ve etkili bir yaklaşım olabilir. Ancak bu nadir klinik tabloya ilişkin standart bir tedavi protokolü henüz bulunmamaktadır.

Anahtar Kelimeler

Hepatik Arter , Diseksiyon , Visseral Arter Diseksiyonu , Bilgisayarlı Tomografi

Spontaneous Hepatic Artery Dissection Presenting with Common Symptoms: A Diagnostic Challenge

https://izlik.org/JA69RS58ES

Öz

Abstract
Introduction: Spontaneous hepatic artery dissection is an extremely rare subtype of isolated visceral artery dissection (IVAD) and often presents with nonspecific abdominal pain, complicating early diagnosis. Prompt recognition is essential, as delayed intervention may result in life-threatening complications including ischemia or rupture.
Case Report: A 44-year-old man with no significant medical history presented with postprandial right upper quadrant pain radiating to the back. Initial examination and laboratory tests, including ultrasound, were inconclusive. Given persistent clinical suspicion, computed tomography angiography revealed a long-segment hepatic artery dissection with near-complete luminal narrowing and intraluminal thrombus. Liver perfusion was preserved, with no biochemical or radiological signs of ischemia. After multidisciplinary consultation, conservative management with anticoagulation and serial Doppler ultrasonography was initiated. The patient remained clinically stable without complications.
Conclusion: This case highlights the diagnostic challenges of hepatic artery dissection and underscores the importance of maintaining clinical suspicion in unexplained abdominal pain. In stable patients without organ ischemia, conservative treatment with close imaging follow-up can be a safe and effective management strategy. Due to its rarity, standardized treatment guidelines for hepatic artery dissection remain undefined.

Anahtar Kelimeler

Hepatic Artery , Dissection , Visceral Artery Dissection , Anticoagulants , Computed Tomography

Etik Beyan

Written informed consent was obtained from the patient for the anonymized use of clinical data and radiological images in this case report. This case report was prepared in accordance with the principles of the Declaration of Helsinki.

Kaynakça

• 1. Shi Y, Guo J, Dong J, Chen X, Luo L, Shen Y. Comparative analysis of prevalence, evaluation, management, and rehabilitation outcome of spontaneous isolated visceral artery dissection: a systematic review and meta-analysis of 80 reports. Int J Surg. 2023;109(3):469-80.
• 2. Park YJ, Park KB, Kim DI, Do YS, Kim DK, Kim YW. Natural history of spontaneous isolated superior mesenteric artery dissection derived from follow-up after conservative treatment. J Vasc Surg. 2011;54(6):1727-33.
• 3. Kang SH, Park HS, Yoon CJ, Shin CS, Yoo KC, Lee T. Mid- to Long- Term Outcomes in Management of Spontaneous Isolated Coeliac Artery Dissection (SICAD). Eur J Vasc Endovasc Surg. 2020;59(2):247-53.
• 4. Kim SR, Park TK, Choi SH, Kim SM, Choe YH, Heo SH, et al. Natural history of spontaneous isolated celiac artery dissection after conservative treatment. J Vasc Surg. 2018;68(1):55-63.
• 5. Nordanstig J, Gerdes H, Kocys E. Spontaneous isolated dissection of the celiac trunk with rupture of the proximal splenic artery: a case report. Eur J Vasc Endovasc Surg. 2009;37(2):194-7.
• 6. Takayama T, Miyata T, Shirakawa M, Nagawa H. Isolated spontaneous dissection of the splanchnic arteries. J Vasc Surg. 2008;48(2):329-33.
• 7. Müller MF, Kim D. Spontaneous dissection of the hepatic artery. Abdom Imaging. 1995;20(5):462-5.
• 8. Dong Z, Fu W, Chen B, Guo D, Xu X, Wang Y. Treatment of symptomatic isolated dissection of superior mesenteric artery. J Vasc Surg. 2013;57(2 Suppl):69s-76s.
• 9. Glehen O, Feugier P, Aleksic Y, Delannoy P, Chevalier JM. Spontaneous dissection of the celiac artery. Ann Vasc Surg. 2001;15(6):687-92.
• 10. Crowhurst TD, Ho P. Hepatic artery dissection in a 65-yearold woman with acute pancreatitis. Ann Vasc Surg. 2011;25(3):386.e17-21.