Operative Treatment of Pediatric Splanchnic Arterial Occlusive Disease


Clinical Presentation

Splanchnic arterial occlusive disease in children is a very uncommon pathologic entity and a rare cause of intestinal ischemic symptoms. This disease is usually recognized as an incidental finding during studies of hypertensive children having abdominal aortic coarctations or renal artery disease. In two earlier publications from our institution, splanchnic artery occlusive lesions were encountered in 22% of patients with abdominal aortic coarctations and in 18% of patients with renal artery stenotic disease.

An occasional child has symptomatic intestinal ischemia manifest by postprandial abdominal pain and a failure to gain or maintain weight. The diagnosis in patients with suspected intestinal angina is most often confirmed by arteriographic imaging ( Figures 1 and 2 ). The stenotic narrowings in these children invariably affect the ostia of the celiac and superior mesenteric arteries.

FIGURE 1, Arteriographic evidence of splanchnic arterial occlusive disease in an adolescent. A, Lateral aortogram with severe celiac and superior mesenteric artery narrowings. B, Anteroposterior aortogram in a young child, exhibiting a large central mesocolic artery collateral originating from the inferior mesenteric artery passing superiorly to the circulatory beds of occluded celiac and superior mesenteric arteries.

FIGURE 2, Lateral aortogram documenting developmental ostial stenoses of the celiac and superior mesenteric arteries in a child with a midabdominal coarctation.

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