Median arcuate ligament syndrome and aneurysm in the pancreaticoduodenal artery detected by retroperitoneal hemorrhage: A case report

Hanaki, Takehiko; Fukuta, Shiori; Okamoto, Masaru; Tsuda, Ayumi; Yagyu, Takuki; Urushibara, Shoichi; Endo, Kenji; Suzuki, Kazunori; Nakamura, Seiichi; Ikeguchi, Masahide

doi:10.1002/ccr3.1643

Cited by 14 publications

(10 citation statements)

References 18 publications

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“…This suggests that awaiting catheter intervention or one-staged procedure in the hybrid operating room is necessary unless intraoperative verification of CA flow using a Doppler flow meter is available. 10 ) We used the transit-time flow meter to confirm SMA blood flow because there was no probe suitable for the size of CA. Measuring the antegrade flow in one of the CA branches would have been useful to detect residual stenosis in the CA.…”

Section: Discussionmentioning

confidence: 99%

A Case of Chronic Mesenteric Ischemia: Complete Revascularization Using Multiple Procedures

Yoshimura

Sakamoto

Hiromoto

et al. 2021

Annals of Vascular Diseases

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Chronic mesenteric ischemia (CMI) involving occlusion and/or stenosis of multiple mesenteric arteries is rare. We report our experience with a 66-year-old man who presented with a more than 3 months history of abdominal pain and vomiting/diarrhea. A diagnosis of CMI due to occlusion of the superior mesenteric artery (SMA) and severe stenosis of the celiac artery by median arcuate ligament syndrome was made. Complete revascularization through iliac artery-SMA bypass grafting and arcuate ligament dissection assisted with staged-catheter intervention successfully alleviated the patientʼs symptoms. The patient has maintained a normal daily diet for 6 months postoperatively.

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Section: Discussionmentioning

confidence: 99%

A Case of Chronic Mesenteric Ischemia: Complete Revascularization Using Multiple Procedures

Yoshimura

Sakamoto

Hiromoto

et al. 2021

Annals of Vascular Diseases

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“…Sanchez et al reported a case of MALS with liver ischemia that improved with conservative follow-up [ 5 ]; the other reported cases of MALS underwent reoperation using a MAL incision [ 3 , 6 ]. In non-acute-onset MALS, surgical MAL incision would be more desirable than endovascular treatment with IVR or arterial bypass [ 2 ], because re-laparotomic procedures after PD would be difficult because of adhesions and effects on the reconstructed organs. Imai et al performed IVR prior to MAL incision, but they eventually performed a second surgery because of CA re-occlusion, which resulted in a third surgery, remnant pancreatectomy, and splenectomy [ 3 ].…”

Section: Discussionmentioning

confidence: 99%

“…Because median arcuate ligament (MAL) syndrome (MALS), also called “celiac axis compression syndrome” [ 1 , 2 ], may be fatal if left untreated at the time of pancreaticoduodenectomy (PD) [ 3 , 4 ], it is diagnosed preoperatively and treated with preoperative interventional radiology (IVR) or intraoperative surgical treatment. However, MALS can also occur postoperatively, even if the diagnosis of MALS is not based on preoperative or intraoperative evaluation [ 3 , 5 , 6 ].…”

Section: Introductionmentioning

confidence: 99%

Successful Interventional Radiology for Acute Median Arcuate Ligament Syndrome After Pancreaticoduodenectomy

Hanaki¹,

Sakamoto²,

Yata³

et al. 2021

Cureus

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Background: Median arcuate ligament (MAL) syndrome (MALS), also known as celiac artery (CA) compression syndrome and Dunbar syndrome, occurs because of extraluminal compression of the CA root by the MAL, which is part of the diaphragm. In MALS, a malposition of the MAL compresses the CA and causes nonspecific symptoms, including epigastric pain after eating, weight loss, nausea, and vomiting and can sometimes cause visceral aneurysms. Typically, in MALS, various chronic ischemic symptoms and visceral aneurysms due to changes in arterial blood flow are observed; however, in acute-onset MALS, acute organ failure due to ischemic changes may be problematic. Surgical treatment is the recommended treatment for MALS, but the optimal treatment of acute MALS that occurs after laparotomy remains controversial because of its rarity. Here, we present the first case of acute MALS, which occurred after pancreaticoduodenectomy (PD) that was successfully treated with interventional radiology (IVR) without reoperation. Case presentation: A 75-year-old man presented with liver infarction after subtotal stomach-preserving PD using the Child method plus Braun enteroenterostomy. As a result of contrast-enhanced computed tomography for the investigation of elevated hepatic cytolysis-related enzymes on the first postoperative day, he was diagnosed with acute MALS resulting from gastrointestinal reconstruction after PD. The patient underwent IVR to restore blood flow of the CA, and an intraluminal stent was inserted. Despite the development of ischemic gastropathy, splenic infarction, and pancreatic fistula, the patient was eventually discharged on postoperative day 82 without any disability. Conclusion: Many studies have reported open, laparoscopic, and robot-assisted MAL incisions for MALS, but few reports have detailed the treatment for postoperative MALS. Here, we report the first case of acute MALS developed after PD that was successfully treated with endovascular CA stenting. For acute MALS after PD, early endovascular treatment may be more useful than re-laparotomy.

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“…Median arcuate ligament syndrome (MALS) is a rare disease that results from extraluminal compression of the coeliac artery by the median arcuate ligament of the diaphragm[ 1 ]. MALS occurs in 2 per 100000 patients[ 1 - 3 ]. Typical clinical findings include postprandial abdominal pain, upper abdominal murmur, and weight loss.…”

Section: Introductionmentioning

confidence: 99%

Median arcuate ligament syndrome with retroperitoneal haemorrhage: A case report

Lu¹,

Jian-guo²,

Xie³

et al. 2022

WJCC

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BACKGROUND Median arcuate ligament syndrome (MALS) is relatively rare and is due to extraluminal compression of the coeliac artery by the median arcuate ligament of the diaphragm. Here, we report a case of MALS found in a patient with abdominal pain and retroperitoneal haemorrhage for education and dissemination. CASE SUMMARY This article describes a 46-year-old female patient who was admitted to our hospital with abdominal pain as her chief complaint. She had experienced no obvious symptoms but had retroperitoneal bleeding during the course of the disease. Contrast-enhanced computed tomography (CT) and noninvasive CT angiography (CTA) led to an initial misdiagnosis of pancreaticoduodenal artery aneurysm (PDAA) causing retroperitoneal hemorrhage. After intraoperative exploration and detailed analysis of enhanced CT and CTA images, a final diagnosis of MALS was made. The cause of the haemorrhage was bleeding from a branch of the gastroduodenal artery, not rupture of a PDAA. The prognosis of MALS combined with PDAA treated by laparoscopy and interventional therapy is still acceptable. The patient was temporarily treated by gastroduodenal suture haemostasis and was referred for further treatment. CONCLUSION MALS is very rare and usually has postprandial abdominal pain, upper abdominal murmur, and weight loss. It is diagnosed by imaging or due to complications. When a patient has abdominal bleeding or PDAA, we should consider whether the patient has celiac trunk stenosis (MALS or other etiology). When abdominal bleeding is combined with an aneurysm, we generally think of aneurysm rupture and hemorrhage first, but it may also be collateral artery rupture and hemorrhage.

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Median arcuate ligament syndrome and aneurysm in the pancreaticoduodenal artery detected by retroperitoneal hemorrhage: A case report

Cited by 14 publications

References 18 publications

A Case of Chronic Mesenteric Ischemia: Complete Revascularization Using Multiple Procedures

A Case of Chronic Mesenteric Ischemia: Complete Revascularization Using Multiple Procedures

Successful Interventional Radiology for Acute Median Arcuate Ligament Syndrome After Pancreaticoduodenectomy

Median arcuate ligament syndrome with retroperitoneal haemorrhage: A case report

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