Injuries to the Celiac Trunk: A Systematic Review of Trauma to Haller’s Tripod

Document Type: Systematic Review

Authors

1 CHSi International, Baghdad Embassy Hospital, Baghdad, Iraq

2 Department of Surgery, University of Kansas Medical Center, Kansas City, Kansas, USA

3 Department of Surgery, Swedish Medical Center, Seattle, Washington, USA

4 Department of Orthopedic Surgery, University of Missouri-Kansas City Medical Center, Kansas City, Kansas, USA

5 Department of Anesthesiology, University of Nebraska Medical Center, Omaha, Nebraska, USA

6 Department of Surgery, Creighton University School of Medicine, Omaha, Nebraska, USA

7 Department of Clinical Science & Translational Research, Creighton University School of Medicine, Omaha, Nebraska, USA

Abstract

Introduction: The celiac artery is nestled deep within the abdomen and provides blood flow to the foregut. Injuries to the celiac artery are rare and carry a high mortality rate.
Methods: A systematic MEDLINE Complete literature search was performed following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Relevant studies, specifically those focusing on diagnosis and management of traumatic celiac arterial injuries were selected, excluding pediatric and iatrogenic cases. Studies from all years were considered, given the paucity of literature on this topic. Studies included in the review were categorized according to level of evidence.
Results: The initial search yielded 5295 results. Specifiers and removing duplicates reduced this number to a final result of 226 studies. After applying exclusion criteria, there were 33 remaining studies containing a total of 175 patients. Of these, only 5 had greater than ten patients in the study, and the majority of the remaining studies were level IV and V evidence. Of the studies reporting deaths, the overall mortality was 34%.
Conclusion: Injuries to the celiac artery are very rare and occur as a result of penetrating or blunt trauma. These injuries carry a high mortality rate and early recognition requires a high index of suspicion. Diagnosis is based on CT imaging or direct visualization during an exploratory laparotomy. Treatment modalities include open repair, endovascular repair, ligation and medical management. Currently, given the lack of available studies, there is no uniform or agreed-upon treatment approach.