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Takagi T, Morita Y, Matsumoto A, Ida S, Muraki R, Kitajima R, Furuhashi S, Takeda M, Kikuchi H, Hiramatsu Y, Takeuchi H. Laparoscopic median arcuate ligament section for median arcuate ligament compression syndrome initially detected as splenic infarction: a case report. Surg Case Rep 2024; 10:41. [PMID: 38358535 PMCID: PMC10869672 DOI: 10.1186/s40792-024-01817-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2023] [Accepted: 01/10/2024] [Indexed: 02/16/2024] Open
Abstract
BACKGROUND Median arcuate ligament compression syndrome (MALS) causes upper abdominal pain and at times hemodynamic abnormalities in the pancreaticoduodenal region. Herein, we present a case of a 70 year-old man, initially diagnosed with splenic infarction and was successfully treated laparoscopically. CASE PRESENTATION A 70-year-old man with abdominal pain admitted to our hospital. Abdominal-enhanced computed tomography revealed a poorly contrasted area in the spleen and stenosis at the root of the celiac artery. Arterial dilatation was observed around the pancreaticoduodenal arcade, however, no obvious aneurysm formation or arterial dissection was observed. Abdominal-enhanced magnetic resonance imaging indicated the disappearance of the flow void at the root of the celiac artery. The patient had no history of atrial fibrillation and was diagnosed with splenic infarction due to median arcuate ligament compression syndrome. We performed a laparoscopic median arcuate ligament section with five ports. Intraoperative ultrasonography showed a retrograde blood flow in the common hepatic artery and the celiac artery. After releasing the compression, the antegrade blood flow from the celiac artery to the splenic artery, and the common hepatic artery were visualized using intraoperative ultrasonography. The postoperative course of the patient was uneventful, and he was discharged on postoperative day 9. Postoperative computed tomography a month after surgery revealed no residual stenosis of the celiac artery or dilation of the pancreaticoduodenal arcade. Furthermore, the poorly contrasted area of the spleen improved. CONCLUSIONS Reports indicate that hemodynamic changes in the abdominal visceral arteries due to median arcuate ligament compression are related to the formation of pancreaticoduodenal aneurysms. In this case, median arcuate ligament compression syndrome caused splenic infarction by reducing blood flow to the splenic artery.
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Affiliation(s)
- Toru Takagi
- Department of Surgery, Hamamatsu University School of Medicine, 1-20-1 Handayama, Higashi-ku, Hamamatsu, 431-3192, Japan
| | - Yoshifumi Morita
- Department of Surgery, Hamamatsu University School of Medicine, 1-20-1 Handayama, Higashi-ku, Hamamatsu, 431-3192, Japan.
- Division of Surgical Care, Morimachi, Hamamatsu University School of Medicine, Hamamatsu, 1-20-1 Handayama, Chuo-ku, 431-3192, Japan.
| | - Akio Matsumoto
- Department of Surgery, Hamamatsu University School of Medicine, 1-20-1 Handayama, Higashi-ku, Hamamatsu, 431-3192, Japan
| | - Shinya Ida
- Department of Surgery, Hamamatsu University School of Medicine, 1-20-1 Handayama, Higashi-ku, Hamamatsu, 431-3192, Japan
| | - Ryuta Muraki
- Department of Surgery, Hamamatsu University School of Medicine, 1-20-1 Handayama, Higashi-ku, Hamamatsu, 431-3192, Japan
| | - Ryo Kitajima
- Department of Surgery, Hamamatsu University School of Medicine, 1-20-1 Handayama, Higashi-ku, Hamamatsu, 431-3192, Japan
| | - Satoru Furuhashi
- Department of Surgery, Hamamatsu University School of Medicine, 1-20-1 Handayama, Higashi-ku, Hamamatsu, 431-3192, Japan
| | - Makoto Takeda
- Department of Surgery, Hamamatsu University School of Medicine, 1-20-1 Handayama, Higashi-ku, Hamamatsu, 431-3192, Japan
| | - Hirotoshi Kikuchi
- Department of Surgery, Hamamatsu University School of Medicine, 1-20-1 Handayama, Higashi-ku, Hamamatsu, 431-3192, Japan
| | - Yoshihiro Hiramatsu
- Department of Perioperative Functioning Care & Support, Hamamatsu University School of Medicine, Hamamatsu, 1-20-1 Handayama, Chuo-ku, 431-3192, Japan
| | - Hiroya Takeuchi
- Department of Surgery, Hamamatsu University School of Medicine, 1-20-1 Handayama, Higashi-ku, Hamamatsu, 431-3192, Japan
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Imagami T, Takayama S, Hattori T, Matsui R, Kani H, Tanaka A, Ando M, Kodani N. Transarterial Embolization With Complementary Surgical Ligation of Gastroduodenal Artery for Ruptured Pancreaticoduodenal Artery Aneurysm. Vasc Endovascular Surg 2019; 53:593-598. [PMID: 31248357 DOI: 10.1177/1538574419859693] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
The association between pancreaticoduodenal artery aneurysm (PDAA) and local hemodynamic changes in pancreaticoduodenal arcades is well established. However, there are few case reports of PDAA associated with acute aortic dissection. In this article, we outline and discuss the case of a 61-year-old man diagnosed with a type A acute aortic dissection who underwent emergency surgery and developed sudden-onset severe abdominal pain and shock 10 days later. Contrast-enhanced computed tomography showed a ruptured PDAA with feeding vessels from the gastroduodenal and superior mesenteric arteries, with evidence that the celiac artery was diverged from a false lumen. Transarterial embolization via the superior mesenteric artery alone was not expected to achieve hemostasis, so we performed a hybrid procedure involving transarterial embolization cannulated from superior mesenteric artery with complementary surgical ligation of the gastroduodenal artery. The postoperative course was uneventful, and follow-up contrast-enhanced computed tomography showed no persistence of the aneurysm 8 days after the second operation. This case proposed that visceral arterial malperfusion due to acute aortic dissection can cause PDAA in the early postoperative period. Although previous reports suggest that endovascular treatment is preferable, it may not always be feasible. Since ruptured PDAAs are often not detected during surgery, surgical treatment can be overly invasive. Whereas, transarterial embolization with complementary clamping or ligation of the gastroduodenal artery for ruptured PDAA is less invasive and can control hemorrhage, especially when cannulation to the celiac artery is impossible. Notably, the technique did not cause organ ischemia, presumably because the small collateral vessels of the pancreaticoduodenal arcades permitted sufficient blood flow. If endovascular treatment is unable to achieve rapid hemostasis, this technique may be a useful option for ruptured PDAA.
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Affiliation(s)
- Toru Imagami
- 1 Department of Surgery, Nagoya Tokushukai General Hospital, Kasugai City, Japan
| | - Satoru Takayama
- 1 Department of Surgery, Nagoya Tokushukai General Hospital, Kasugai City, Japan
| | - Taku Hattori
- 1 Department of Surgery, Nagoya Tokushukai General Hospital, Kasugai City, Japan
| | - Ryohei Matsui
- 1 Department of Surgery, Nagoya Tokushukai General Hospital, Kasugai City, Japan
| | - Hisanori Kani
- 1 Department of Surgery, Nagoya Tokushukai General Hospital, Kasugai City, Japan
| | - Akimitsu Tanaka
- 2 Department of Cardiology of Heart Center, Nagoya Tokushukai General Hospital, Kasugai City, Japan
| | - Miyuki Ando
- 2 Department of Cardiology of Heart Center, Nagoya Tokushukai General Hospital, Kasugai City, Japan
| | - Noriko Kodani
- 3 Department of Cardiovascular Surgery, Nagoya Tokushukai General Hospital, Kasugai City, Japan
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Wink C, Ferrazzi G, Bassenge JP, Flassbeck S, Schmidt S, Schaeffter T, Schmitter S. 4D flow imaging with 2D‐selective excitation. Magn Reson Med 2019; 82:886-900. [DOI: 10.1002/mrm.27769] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2018] [Revised: 02/27/2019] [Accepted: 03/20/2019] [Indexed: 01/18/2023]
Affiliation(s)
- Clarissa Wink
- Physikalisch‐Technische Bundesanstalt (PTB) Braunschweig and Berlin Germany
| | - Giulio Ferrazzi
- Physikalisch‐Technische Bundesanstalt (PTB) Braunschweig and Berlin Germany
| | - Jean Pierre Bassenge
- Physikalisch‐Technische Bundesanstalt (PTB) Braunschweig and Berlin Germany
- Working Group on Cardiovascular Magnetic Resonance, Experimental and Clinical Research Center, a Joint Cooperation between the Charité Medical Faculty and the Max‐Delbrueck Center for Molecular Medicine Berlin Germany
| | - Sebastian Flassbeck
- Medical Physics in Radiology German Cancer Research Center (DKFZ) Heidelberg Germany
- Faculty of Physics and Astronomy Heidelberg University Heidelberg Germany
| | - Simon Schmidt
- Medical Physics in Radiology German Cancer Research Center (DKFZ) Heidelberg Germany
- Faculty of Physics and Astronomy Heidelberg University Heidelberg Germany
| | - Tobias Schaeffter
- Physikalisch‐Technische Bundesanstalt (PTB) Braunschweig and Berlin Germany
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