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Abstract：
The celiacomesenteric trunk (CMT), an exceedingly rare anatomic variant uniting the celiac artery and superior mesenteric artery (SMA), holds significant clinical and surgical implications. Despite its rarity, understanding these implications is crucial for effective management. This report outlines the case of a 99-year-old female presenting with septic shock and abdominal pain, with imaging revealing an incidental CMT. This paper aims to elucidate the surgical implications associated with CMT through a comprehensive case review and literature search. A 99-year-old female with multiple cardiovascular comorbidities presented with altered mental status and right lower quadrant abdominal pain. Upon arrival, the patient exhibited disorientation, an inability to follow commands, hypoxia, and hypotension. Significant laboratory findings included a white count of 20.6 x 109/L, lactate of 6.1 mmol/L, glucose of 53 mg/dL, alanine transaminase (ALT)/aspartate aminotransferase (AST) of 186/336 U/L, and creatinine of 4.2 mg/dL. Immediate interventions involved high-flow oxygen, fluid resuscitation, intravenous antibiotics, and admission to the ICU for septic shock. A CT angiogram (CTA) revealed an incidental large common trunk comprising the celiac trunk and superior mesenteric artery (SMA). There was a high-grade stenosis at the origin of the SMA. However, all the vessels were widely patent distally, and acute mesenteric occlusion was ruled out. By day 12, the patient achieved clinical stability after conservative management and was discharged. Complications such as aneurysm, dissection, stenosis, thrombosis, or acute occlusion of a CMT may necessitate complex surgical interventions, including endovascular procedures or open hepatic surgery. Understanding these technical complexities is vital for avoiding surgical complications in critically ill patients.
摘要：
腹腔肠干(CMT)，一种极其罕见的解剖变异，将腹腔动脉和肠系膜上动脉（SMA）结合在一起，具有重要的临床和手术意义。尽管它很罕见,理解这些含义对于有效管理至关重要。本报告概述了一名99岁女性出现感染性休克和腹痛的病例，成像显示附带的CMT。本文旨在通过全面的病例回顾和文献检索，阐明与CMT相关的手术意义。一名99岁的女性，患有多种心血管合并症，表现为精神状态改变和右下腹腹痛。抵达后,病人表现出迷失方向，无法服从命令，缺氧,和低血压。重要的实验室发现包括20.6x109/L的白色计数，乳酸为6.1mmol/L，53mg/dL的葡萄糖，丙氨酸转氨酶(ALT)/天冬氨酸转氨酶(AST)186/336U/L,肌酐为4.2mg/dL。即时干预涉及高流量氧气，液体复苏,静脉注射抗生素,并因感染性休克进入ICU。CT血管造影（CTA）显示附带的大共同干，包括腹腔干和肠系膜上动脉（SMA）。在SMA的起源处存在高度狭窄。然而,所有的血管在远端都有广泛的专利，排除急性肠系膜闭塞。到第12天，患者在保守治疗后达到临床稳定并出院。并发症如动脉瘤，解剖,狭窄,血栓形成,或CMT的急性闭塞可能需要复杂的手术干预，包括血管内手术或开放肝脏手术。了解这些技术复杂性对于避免危重患者的手术并发症至关重要。
