Abdominal Angina and Intestinal Gangrene-Catastrophic Presentation of Thrombosis of Common Hepato-SplenoMesenteric Trunk (HSMT): A Rare Case Report

Abstract

Middle age patient was presented in emergency department with complains of acute abdominal pain, vomiting and diarrhea. On clinical examination there was board like rigidity and tender abdomen. Initial labs were unremarkable. Filling defect was seen in an anomalous channel, hepato-spleno-mesenteric trunk that was seen as a supply of liver, spleen, small bowel and part of large bowel on contrast enhanced computed tomography. The left gastric artery was seen arising separately from aorta. Emergency exploratory laprotomy was done. Patchy discoloration and cyanosis with friability was seen in liver and spleen representing ischemia. Gangrene of small bowel and proximal large bowel (till the splenic lexure) was seen. The patient expired few days after presentation. No other surgical intervention was done. This was an unusual case of abdominal angina due to thrombosis of a rare arterial variation of gastrointestinal vascularity. The hepato-spleno-mesenteric trunk was seen thrombosed which happens to be the only artery supplying the midgut and its embryological visceral derivatives in the subjects it occur in. However, in cases like these there is a possibility of collateral supply from esophageal, phrenic and inferior mesenteric arteries.