Isolated coeliac artery dissection after blunt trauma is a rare condition, the least frequent of all abdominal vascular injuries. Typically, it results from penetrating trauma. The majority of the cases in the literature is associated with severe visceral or vascular injuries . Risk factors include atherosclerosis, trauma, fibromuscular dysplasia, connective tissue disorders, and previous abdominal surgery that may weaken the vessel wall [2, 3]. In addition, any mechanism increasing the intraluminal flow rate, such as stenosis or occlusion of another abdominal artery may predispose to artery dissection . In some patients and particularly during expiration, there is compression of the coeliac artery by the median arcuate ligament. It has been suggested that a rapid increase of blood flow during expiration predisposes to weakness of the vessel wall, promoting aneurismal formation  which then may pose an increased risk of dissection.
In coeliac dissection patients may present with epigastric bruit, intestinal angina, weight loss and postprandial pain, associated with nausea, vomiting, or diarrhoea. Symptoms of liver failure may be present such as jaundice, elevated transaminases, and hypocoagulation. Initial CT may be negative for dissection and should be repeated if clinical suspicion of dissection is high, in order to avoid the severe consequences of liver failure secondary to thrombosis and infarction [1, 2].
Sonography is considered the initial modality of choice for patients with abdominal pain, but visceral arteries may be difficult to assess. CTA findings include an intimal flap, false lumen thrombosis, infiltration of surrounding fat, aneurysm of the coeliac trunk and its branches. Splenic infarctions may be present . The specificity and sensitivity of CTA are up to 95% making it the gold standard. Conventional angiography may be useful in doubtful cases but is not systematically used because of its invasiveness .
Treatment of coeliac dissection includes haemodynamic surveillance, pain control, and anticoagulation [1, 2]. Endovascular stent placement should be discussed in cases of hepatic or splenic infarction. In general, liver failure and signs of acute bleeding are associated with poor prognosis . Our patient developed splenic infarcts on follow-up CTA as well as worsening liver function tests. Stent placement was not possible because of the presence of an arcuate ligament necessitating an aorto-hepatic bypass.
In conclusion, isolated coeliac dissection is a rare condition after blunt abdominal trauma. Arcuate ligament likely presents a risks factor. Coeliac dissection may be diagnosed on initial sonography but CTA remains the gold standard.