Aneurysms of Pancreaticoduodenal Artery due to Median Arcuate Ligament Syndrome, Treated by Open Surgery and Laparoscopic Surgery

Abstract

Introduction There are many possible causes of an abdominal visceral aneurysm, including the obstruction of the celiac artery by the median arcuate ligament (MAL). We report two cases of an aneurysm of the pancreaticoduodenal artery due to MAL syndrome that we treated surgically. Case Presentation Case 1: a 66-year-old Japanese woman was diagnosed with a rupture of an aneurysm of the inferior pancreaticoduodenal artery. Because of the difficulty of endovascular therapy, we performed an emergency operation. We chose an abdominal operation, and the postoperative course was uneventful. Case 2: a 75-year-old Japanese man presented at our hospital with acute abdominal pain, nausea, and cold sweat. Our experience of treating MAL syndrome in case 1 enabled us to diagnose the disease accurately. We chose laparoscopic surgery, and the postoperative course was uneventful. Discussion There are several treatment choices for an aneurysm of the pancreaticoduodenal artery due to MAL syndrome. We have performed only a release of the MAL for treatment, but it is difficult to conclude whether only releasing the MAL is enough to ensure a positive long-term prognosis. Regular follow-up is needed in such cases. Conclusion Laparoscopic surgery can be considered one of the options for MAL syndrome.

Resection and reconstruction of pancreatic artery aneurysms caused by the compression of the celiac trunk by the median arcuate ligament: a report of two cases

“…So far, there has been no therapeutic guideline or strategy for PAAs caused by MAL compression to the celiac trunk. Four main therapeutic options have been reported, namely MAL division [1,5], stenting into the celiac trunk [6,7], coil embolization into the aneurysm [2,[8][9][10][11], and resection and reconstruction of aneurysms [12,13].…”

“…First, MAL division has been reported to be effective in some cases [1,5]. MAL division can be carried out not only by an open surgery [1] but also by a laparoscopic surgery [5].…”

Median Arcuate Ligament Syndrome With Celiac Artery Aneurysm and Dissection

“…Median arcuate ligament syndrome is known to cause stenosis of the celiac artery, causing true aneurysms distal to the stenosis, commonly also involving the pancreaticoduodenal artery aneurysm. 9 This aneurysmal development is believed to be related to hemodynamic changes due to increased blood flow in the collateral arteries and poststenosis increased arterial wall shear stress. 9 These aneurysms at times can be rapidly progressive and could result in rupture and hemorrhagic shock.…”

“…9 This aneurysmal development is believed to be related to hemodynamic changes due to increased blood flow in the collateral arteries and poststenosis increased arterial wall shear stress. 9 These aneurysms at times can be rapidly progressive and could result in rupture and hemorrhagic shock. 9 These aneurysms and associated complications are normally addressed by endovascular techniques, though the stenosis should be addressed by surgical release of ligament.…”

“…9 These aneurysms at times can be rapidly progressive and could result in rupture and hemorrhagic shock. 9 These aneurysms and associated complications are normally addressed by endovascular techniques, though the stenosis should be addressed by surgical release of ligament. 10 In the event that surgical release is insufficient and the celiac artery stenosis persists, other modalities have been described that can offer additional help.…”