Laparoscopic treatment of celiac axis compression by the median arcuate ligament and endovascular repair of a pancreaticoduodenal artery aneurysm: case report. | LitMetric
Compression of the celiac axis by the median arcuate ligament of the diaphragm can cause nonspecific symptoms such as abdominal pain, vomiting, and weight loss. There is a known association between stenosis or occlusion of the celiac trunk and aneurysms of the pancreaticoduodenal artery. Treatment strategies for patients who have this association should be selected on a case-by-case basis. We describe the case of a patient with pancreaticoduodenal artery aneurysm associated with compression of the celiac trunk by the arcuate ligament, which were managed with endovascular and laparoscopic techniques, respectively.
Background: Median arcuate ligament syndrome (MALS) occurs due to extrinsic compression of the coeliac plexus, leading to postprandial and exercise-induced epigastric pain, nausea, vomiting, food fear and weight loss. Diagnosis can be challenging as up to 25% of the population have radiological compression. However, only 1% of the population have corresponding symptoms.
Dieulafoy lesions are a rare cause of gastrointestinal bleeding, characterized by an enlarged submucosal blood vessel that bleeds without visible abnormalities. The diagnosis is typically made via endoscopy, and treatment usually involves endoscopic therapy. This case involves a 46-year-old female who presented with upper gastrointestinal bleeding due to a Dieulafoy's lesion, treated with band ligation and later embolization after the lesion was found to originate from the left phrenic artery.
Inferior pancreaticoduodenal artery aneurysm (IPDA) with the stenosis of the celiac axis is rare and may cause rupture. A unique etiology of IPDAs with celiac stenosis is median arcuate ligament syndrome. These aneurysms develop as a result of the dilation of the arteries from the retrograde blood flow into the pancreaticoduodenal arches because of celiac artery compression by the median arcuate ligament.
Department of Surgery, Division of Surgical Oncology, University of Pittsburgh, 200 Lothrop St, 3rd Fl, Suite D380, Digestive Disorder Clinic, Pittsburgh, PA, 15213-2536, USA.
* Median arcuate ligament syndrome (MALS) is an uncommon cause of this stenosis, and surgical release of the ligament beforehand has a high success rate in resolving related ischemic problems.
* A 49-year-old male with pancreatic adenocarcinoma benefited from robotic-assisted ligament release before his surgery, which helped prevent complications and ensured proper blood flow during the procedure.
- Median arcuate ligament syndrome results in the celiac artery being compressed, leading to reduced blood flow and potential aneurysm formation in the pancreatic area; it was observed in six cases during the COVID-19 pandemic.
- Patients experienced abdominal pain 3 to 9 days after COVID-19 onset, although none required oxygen, and diagnoses were confirmed using contrast-enhanced CT scans showing hemorrhage and aneurysms.
- While rare, retroperitoneal hemorrhage related to this syndrome may be exacerbated by COVID-19, causing complications like duodenal stenosis and portal vein thrombosis in some patients.
