Acute median arcuate ligament syndrome after pancreaticoduodenectomy
Abstract Background Median arcuate ligament syndrome (MALS) can cause severe complications after pancreaticoduodenectomy (PD). Most of the reported cases of MALS have been diagnosed perioperatively and can be treated efficiently by interventional radiology or division of the median acute ligament (M...
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Japan Surgical Society
2018-11-01
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| Series: | Surgical Case Reports |
| Online Access: | http://link.springer.com/article/10.1186/s40792-018-0545-x |
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| author | Daisuke Imai Takashi Maeda Huanlin Wang Takahiro Ohmine Keitaro Edahiro Makoto Edagawa Tomoyoshi Takenaka Shohei Yamaguchi Kozo Konishi Shinichi Tsutsui Hiroyuki Matsuda |
| author_facet | Daisuke Imai Takashi Maeda Huanlin Wang Takahiro Ohmine Keitaro Edahiro Makoto Edagawa Tomoyoshi Takenaka Shohei Yamaguchi Kozo Konishi Shinichi Tsutsui Hiroyuki Matsuda |
| author_sort | Daisuke Imai |
| collection | DOAJ |
| description | Abstract Background Median arcuate ligament syndrome (MALS) can cause severe complications after pancreaticoduodenectomy (PD). Most of the reported cases of MALS have been diagnosed perioperatively and can be treated efficiently by interventional radiology or division of the median acute ligament (MAL) fibers. Case report A 69-year-old woman underwent PD with resection of the SMV for pancreatic head cancer. Intraoperative exploration showed normal anatomy of the celiac trunk. Intraoperative digital palpation revealed normal pulsation of the common hepatic artery after resection of the gastroduodenal artery. On postoperative day (POD) 3, her liver function tests were abnormal, and bloody fluids were found in the drain. Abdominal CT showed necrosis of the pancreatic body and ischemia in the liver secondary to MALS which was not detected in the preoperative CT. Interventional radiology was tried first but failed. Division of the MAL fibers markedly increased the blood flow in the hepatic artery. Resection of the remnant pancreas and spleen was also performed simultaneously. Abdominal CT on POD 20 showed re-occlusion of the celiac artery. She experienced rupture of the gastrojejunostomy site, severe hepatic cytolysis, and choledochojejunostomy stricture thereafter. Conclusions This is the third case of MALS that has developed acutely after PD. MALS can cause refractory complications even after MAL release. |
| format | Article |
| id | doaj-art-650b2cf747fb464d8bc9f50b3e3ff111 |
| institution | DOAJ |
| issn | 2198-7793 |
| language | English |
| publishDate | 2018-11-01 |
| publisher | Japan Surgical Society |
| record_format | Article |
| series | Surgical Case Reports |
| spelling | doaj-art-650b2cf747fb464d8bc9f50b3e3ff1112025-08-20T03:14:42ZengJapan Surgical SocietySurgical Case Reports2198-77932018-11-01411510.1186/s40792-018-0545-xAcute median arcuate ligament syndrome after pancreaticoduodenectomyDaisuke Imai0Takashi Maeda1Huanlin Wang2Takahiro Ohmine3Keitaro Edahiro4Makoto Edagawa5Tomoyoshi Takenaka6Shohei Yamaguchi7Kozo Konishi8Shinichi Tsutsui9Hiroyuki Matsuda10Department of Surgery, Hiroshima Red Cross Hospital and Atomic Bomb Survivors HospitalDepartment of Surgery, Hiroshima Red Cross Hospital and Atomic Bomb Survivors HospitalDepartment of Surgery, Hiroshima Red Cross Hospital and Atomic Bomb Survivors HospitalDepartment of Surgery, Hiroshima Red Cross Hospital and Atomic Bomb Survivors HospitalDepartment of Surgery, Hiroshima Red Cross Hospital and Atomic Bomb Survivors HospitalDepartment of Surgery, Hiroshima Red Cross Hospital and Atomic Bomb Survivors HospitalDepartment of Surgery, Hiroshima Red Cross Hospital and Atomic Bomb Survivors HospitalDepartment of Surgery, Hiroshima Red Cross Hospital and Atomic Bomb Survivors HospitalDepartment of Surgery, Hiroshima Red Cross Hospital and Atomic Bomb Survivors HospitalDepartment of Surgery, Hiroshima Red Cross Hospital and Atomic Bomb Survivors HospitalDepartment of Surgery, Hiroshima Red Cross Hospital and Atomic Bomb Survivors HospitalAbstract Background Median arcuate ligament syndrome (MALS) can cause severe complications after pancreaticoduodenectomy (PD). Most of the reported cases of MALS have been diagnosed perioperatively and can be treated efficiently by interventional radiology or division of the median acute ligament (MAL) fibers. Case report A 69-year-old woman underwent PD with resection of the SMV for pancreatic head cancer. Intraoperative exploration showed normal anatomy of the celiac trunk. Intraoperative digital palpation revealed normal pulsation of the common hepatic artery after resection of the gastroduodenal artery. On postoperative day (POD) 3, her liver function tests were abnormal, and bloody fluids were found in the drain. Abdominal CT showed necrosis of the pancreatic body and ischemia in the liver secondary to MALS which was not detected in the preoperative CT. Interventional radiology was tried first but failed. Division of the MAL fibers markedly increased the blood flow in the hepatic artery. Resection of the remnant pancreas and spleen was also performed simultaneously. Abdominal CT on POD 20 showed re-occlusion of the celiac artery. She experienced rupture of the gastrojejunostomy site, severe hepatic cytolysis, and choledochojejunostomy stricture thereafter. Conclusions This is the third case of MALS that has developed acutely after PD. MALS can cause refractory complications even after MAL release.http://link.springer.com/article/10.1186/s40792-018-0545-x |
| spellingShingle | Daisuke Imai Takashi Maeda Huanlin Wang Takahiro Ohmine Keitaro Edahiro Makoto Edagawa Tomoyoshi Takenaka Shohei Yamaguchi Kozo Konishi Shinichi Tsutsui Hiroyuki Matsuda Acute median arcuate ligament syndrome after pancreaticoduodenectomy Surgical Case Reports |
| title | Acute median arcuate ligament syndrome after pancreaticoduodenectomy |
| title_full | Acute median arcuate ligament syndrome after pancreaticoduodenectomy |
| title_fullStr | Acute median arcuate ligament syndrome after pancreaticoduodenectomy |
| title_full_unstemmed | Acute median arcuate ligament syndrome after pancreaticoduodenectomy |
| title_short | Acute median arcuate ligament syndrome after pancreaticoduodenectomy |
| title_sort | acute median arcuate ligament syndrome after pancreaticoduodenectomy |
| url | http://link.springer.com/article/10.1186/s40792-018-0545-x |
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