Compression of the Celiac Trunk Caused by Median Arcuate Ligament in Children and Adolescent Subjects: Evaluation with Contrast-enhanced MR Angiography and Comparison with Doppler US Evaluation

Abstract Background Some patients with the compression of the celiac trunk by the median arcuate ligament (MAL) suffer pancreatic artery aneurysms (PAAs) due to excessive blood flow from the superior mesenteric artery. These aneurysms are in peril because they are prone to rupture irrespective of size. Here, we present two cases of resection and reconstruction of PAAs caused by the compression of the celiac trunk by the MAL. Case presentation Patient 1 was a 44-year-old man who was first diagnosed to have a visceral artery aneurysm with a diameter of 4 cm accidentally found by ultrasound examination at a regular medical check-up. Contrast-enhanced CT revealed the compression of the celiac trunk by the MAL and a PAA originating from the first jejunal artery. First, laparoscopic excision of the MAL followed by a stent placement into the celiac trunk was performed. Although the stent was patent, the PAA still grew. The patient underwent resection and reconstruction of the PAA. Reconstruction of the pancreatic arterial arcade was needed because clamping of the inferior pancreaticoduodenal artery (IPDA) resulted in disappearance of the hepatic arterial blood flow. The follow-up CT 2 years and 9 months after the operation revealed no recurrence of aneurysms and the patent anastomosis. Patient 2 was a 68-year-old man who presented with an epigastric pain. Contrast-enhanced CT revealed the compression of the celiac trunk by the MAL and a PAA approximately 6 cm in diameter originating from the IPDA. The PAA was surrounded by a relatively low-intensity area, suggesting impending rupture of the PAA. The patient underwent resection and reconstruction of the PAA under an emergency situation. Reconstruction of the pancreatic arterial arcade was needed because clamping of the inflow IPDA resulted in disappearance of the hepatic blood flow. The follow-up CT 1 year and 8 months after the operation revealed no recurrence of aneurysms and the patent anastomosis. Conclusions Although long-term follow-up is needed, resection and reconstruction is one of the therapeutic choices for PAAs caused by the compression of the celiac trunk by the MAL in order to prevent catastrophic aneurysm rupture.

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Management for traumatic hepatic injury diagnosed by contrast-enhanced ultrasonography in a patient with an occluded coeliac axis: a case report

Journal of International Medical Research ◽

10.1177/03000605211019926 ◽

2021 ◽

Vol 49 (6) ◽

pp. 030006052110199

Author(s):

Young Hoon Sul ◽

Yook Kim

Keyword(s):

Case Report ◽

Hepatic Artery ◽

Hepatic Injury ◽

Active Bleeding ◽

Organ Injury ◽

Solid Organ ◽

Median Arcuate Ligament ◽

Contrast Enhanced ◽

Arcuate Ligament ◽

Contrast Enhanced Ultrasonography

Transcatheter arterial embolization (TAE) is the standard of care for haemodynamically-stable patients with blunt hepatic injury but it is sometimes impossible due to unfavourable vascular anatomies. This case report describes a 43-year-old male patient with abdominal pain following a motorcycle accident. Based on computed tomography (CT) findings, he was diagnosed with high-grade hepatic injury with coeliac axis stenosis (CAS) due to compression by the median arcuate ligament, and an aberrant right hepatic artery. Contrast-enhanced ultrasonography (CEUS) demonstrated multiple high echogenic tubular and ovoid structures suggestive of active bleeding within the injured liver area. Angiography revealed unique interlobar and intrahepatic collateral vessels between the right and left hepatic arteries. Liver haemorrhages were also identified. Catheterization of the feeding arteries through the collateral pathway was unsuccessful, so a decision was made to cannulate the stenotic portion of the coeliac trunk with a 5-Fr Yashiro catheter. After several attempts, the microcatheter was successfully advanced coaxially into the common hepatic artery. Embolization was performed with a 1:2 mixture of N-butyl cyanoacrylate and iodized oil. Successful haemostasis was confirmed following TAE. CEUS helped clinicians identify active bleeding following traumatic solid organ injury. TAE was a safe and effective treatment strategy. Before performing TAE, attention should be given to the presence of CAS associated with compression by the median arcuate ligament.

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Compression of the Celiac Trunk by the Median Arcuate Ligament

Radiology ◽

10.1148/radiology.214.2.r00nv35604a ◽

2000 ◽

Vol 214 (2) ◽

pp. 604-606 ◽

Cited By ~ 3

Author(s):

Brian Funaki

Keyword(s):

Celiac Trunk ◽

Median Arcuate Ligament ◽

Arcuate Ligament

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Robotic approach to treat Median Arcuate Ligament syndrome: a case report

Journal of Surgical Case Reports ◽

10.1093/jscr/rjaa088 ◽

2020 ◽

Vol 2020 (5) ◽

Author(s):

Roberto Bustos ◽

Michail Papamichail ◽

Alberto Mangano ◽

Valentina Valle ◽

Pier Cristoforo Giulianotti

Keyword(s):

Case Report ◽

Ct Scan ◽

Epigastric Pain ◽

Celiac Trunk ◽

Robotic Approach ◽

Median Arcuate Ligament ◽

Median Arcuate Ligament Syndrome ◽

Clinical Diagnostic ◽

Arcuate Ligament ◽

History Of

Abstract The Median Arcuate Ligament (MAL) syndrome is the symptomatic compression of the celiac trunk by the MAL and other ganglionic periaortic tissue. Despite its rarity, this condition is significant from a clinical, diagnostic and management standpoint and it is usually a diagnosis of exclusion. A 61-year-old female with history of intermittent postprandial epigastric pain was diagnosed with MAL syndrome during CT scan imaging (no other causes of pain were identified). Patient successfully underwent robotic MAL release with symptoms improvement after surgery. The robotic approach is feasible and may allow a very precise and delicate dissection with release of the MAL.

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Chronic abdominal pain as a manifestation of congenital compressional stenosis of the celiac trunk in children: world and own experience

Voprosy praktičeskoj pediatrii ◽

10.20953/1817-7646-2020-4-62-68 ◽

2020 ◽

Vol 15 (4) ◽

pp. 62-68

Author(s):

R.A. Zainulabidov ◽

◽

A.Yu. Razumovsky ◽

A.I. Khavkin ◽

◽

...

Keyword(s):

Abdominal Pain ◽

Lymph Nodes ◽

Congenital Abnormality ◽

Celiac Trunk ◽

Chronic Abdominal Pain ◽

Median Arcuate Ligament ◽

Modern Methods ◽

Arcuate Ligament ◽

Dunbar Syndrome ◽

Methods Of Treatment

Celiac trunk compression stenosis or Dunbar's syndrome, characterized by chronic abdominal pain, is a congenital abnormality based on compression of the celiac trunk by the inner legs of the median arcuate ligament of the diaphragm and neurofibrous tissue of the celiac plexus. In the overwhelming majority of cases, Dunbar's syndrome is a congenital malformation, but variants of compression of the celiac trunk by enlarged lymph nodes are also possible and is considered an acquired disease. The review considers modern methods of treatment of Dunbar syndrome in children and the supervision of this group of patients. Key words: Compression celiac trunk stenosis in children, Dunbar syndrome, median arcuate ligament tsyndrome

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Aneurysms of Peripancreatic Arterial Arcades Coexisting with Celiac Trunk Stenosis or Occlusion: Single Institution Experience

BioMed Research International ◽

10.1155/2017/1645013 ◽

2017 ◽

Vol 2017 ◽

pp. 1-5 ◽

Cited By ~ 2

Author(s):

Robert Antoniak ◽

Laretta Grabowska-Derlatka ◽

Ireneusz Nawrot ◽

Andrzej Cieszanowski ◽

Olgierd Rowiński

Keyword(s):

Celiac Trunk ◽

Celiac Axis ◽

Therapeutic Implications ◽

Common Location ◽

Contrast Enhanced Ct ◽

Contrast Enhanced ◽

Axis Compression ◽

Arcuate Ligament ◽

Collateral Pathways ◽

Size And Morphology

Introduction. True aneurysms of peripancreatic arterial arcades (PAAAs) are rare. Most of them coexist with celiac axis stenosis/occlusion due to median arcuate ligament (MAL) compression or atherosclerosis. The aim of this study was to evaluate the cause of celiac axis lesion and characterize the anatomy of the aneurysms. These findings may have important management implications. Material and Methods. A retrospective analysis of 15 patients with true PAAAs was performed. The diagnosis was established by contrast-enhanced CT, using a 64-MDCT scanner. We evaluated the most probable cause of celiac axis lesion. Aneurysms were characterized by their number, location, size, and morphology. Location of the aneurysms was classified either as pancreaticoduodenal arteries (PDA) or as dorsal pancreatic arteries (DPA) as they may represent different collateral pathways between superior mesenteric artery and celiac trunk. Results. A total of 32 true PAAAs were identified. Celiac trunk was occluded in 12 patients and critically narrowed in 3 patients. Celiac axis lesion was categorized as secondary to MAL compression in 14 cases and due to atherosclerosis in 1 case. The most common location of the aneurysms was inferior pancreaticoduodenal arteries. Only in 1 case aneurysms involved both PDA and DPA. Conclusions. Coexistence of PAAAs with celiac axis compression as well as involvement of either PDAs or DPAs has important therapeutic implications. The uninvolved collateral pathway may be sufficient to preserve effective circulation in celiac trunk branches in case of resection or embolization of the aneurysms. However, further studies are crucial to confirm our findings.

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Median Arcuate Ligament Compression of the Celiomesenteric Trunk

Journal of Clinical Imaging Science ◽

10.4103/2156-7514.75260 ◽

2011 ◽

Vol 1 ◽

pp. 8 ◽

Cited By ~ 7

Author(s):

Victor Lee ◽

Mauricio Daniel Alvarez ◽

Shweta Bhatt ◽

Vikram S. Dogra

Keyword(s):

Computed Tomography ◽

Ct Angiography ◽

Three Dimensional ◽

Celiac Trunk ◽

Median Arcuate Ligament ◽

Rare Variation ◽

Rare Phenomenon ◽

Intestinal Angina ◽

Arcuate Ligament ◽

Celiomesenteric Trunk

Median arcuate ligament (MAL) syndrome is a controversial condition characterized by compression of the celiac trunk and symptoms of intestinal angina. We present a case of MAL compressing the celiomesenteric trunk, a rare variation. We report computed tomography (CT) angiography and three-dimensional reconstructions of this rare phenomenon.

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Multiple Aneurysms of the Inferior Pancreaticoduodenal Artery: A Rare Complication of Acute Pancreatitis

Case Reports in Vascular Medicine ◽

10.1155/2013/621350 ◽

2013 ◽

Vol 2013 ◽

pp. 1-5 ◽

Cited By ~ 1

Author(s):

Chris Klonaris ◽

Emmanouil Psathas ◽

Athanasios Katsargyris ◽

Stella Lioudaki ◽

Achilleas Chatziioannou ◽

...

Keyword(s):

Acute Pancreatitis ◽

Rare Complication ◽

Celiac Trunk ◽

Celiac Artery ◽

Median Arcuate Ligament ◽

Pancreaticoduodenal Artery ◽

Median Arcuate Ligament Syndrome ◽

Arcuate Ligament ◽

History Of ◽

Technical Considerations

Inferior pancreaticoduodenal artery (IPDA) aneurysms are uncommon, representing nearly 2% of all visceral aneurysms, and sporadically associated with celiac artery stenosis. Multiple IPDA aneurysms have been rarely reported. We report a case of a 53-year-old female patient with a history of prior pancreatitis, who presented with two IPDA aneurysms combined with median arcuate ligament-syndrome-like stenosis of the celiac trunk. The patient was treated successfully with coil embolization under local anesthesia. The procedure is described and illustrated in detail and the advantages and technical considerations of such an approach are also being discussed.

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Dunbar syndrome as a cause of chronic abdominal pain in a 24-year-old female

Case Reports in Internal Medicine ◽

10.5430/crim.v7n1p15 ◽

2020 ◽

Vol 7 (1) ◽

pp. 15

Author(s):

Zachary A Koenig ◽

Joel Yednock

Keyword(s):

Abdominal Pain ◽

Duplex Ultrasound ◽

Celiac Trunk ◽

Celiac Artery ◽

Median Arcuate Ligament ◽

External Compression ◽

Cross Sectional ◽

Downward Displacement ◽

Arcuate Ligament ◽

Dunbar Syndrome

External compression of the celiac artery by the median arcuate ligament is referred to as Dunbar syndrome, which is an eponym for celiac axis syndrome or median arcuate ligament syndrome. It is correlated with the archetypal triad of postprandial abdominal pain, weight loss of greater than 20 pounds, and an abdominal bruit on auscultation. This is often accompanied by epigastric tenderness, vomiting, and nausea. Given its lack of symptomatic specificity, Dunbar syndrome is a diagnosis of exclusion for unexplained episodic abdominal discomfort. Here, we present a unique case of a 24-year-old woman who experienced several months of chronic abdominal distress and an extensive workup prior to being diagnosed with Dunbar syndrome. The diagnosis was made via cross-sectional abdominal imaging and duplex ultrasound with respiratory maneuvers, which showed downward displacement of the celiac trunk, post-stenotic dilatation, and increased flow velocity on expiration. She underwent successful laparoscopic division of the median arcuate ligament which greatly alleviated her pain.

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