Enhanced Vascular Collateralization Through the Pancreaticoduodenal Arcade Secondary to Median Arcuate Ligament Compression of the Celiac Axis in the Setting of Pancreatic Body Adenocarcinoma: The Ideal Scenario for the Modified Appleby Procedure

Median arcuate ligament (MAL) syndrome results from extrinsic compression of the celiac axis and or celiac ganglion by the MAL and diaphragmatic crura. A seventy five years lady presented with post prandial epigastric pain for 6 months. She had undergone considerable investigations for other diagnoses before an abdominal computed tomography (CT) revealed median arcuate ligament impinging celiac artery at its origin. She successfully underwent laparotomy and release of median arcuate ligament.

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Pancreatic head resections in the setting of celiac axis stenosis: Case report and review of literature

10.33699/pis.2021.100.5.242-245 ◽

2021 ◽

Vol 100 (5) ◽

Keyword(s):

Case Report ◽

Pancreatic Head ◽

Liver Function Tests ◽

Whipple Procedure ◽

Celiac Axis ◽

Median Arcuate Ligament ◽

Celiac Axis Stenosis ◽

Fast Recognition ◽

Ischemic Complications ◽

Arcuate Ligament

Introduction: Ischemic complications are a notable cause of morbidity in patients after pancreatic head resections. Stenosis of celiac axis in patients undergoing pancreatoduodenectomy requires further perioperative attention. Case report: We present a patient with pancreatic head malignancy scheduled for Whipple procedure in the setting of hemodynamically significant celiac axis stenosis. Despite release of the artery from compression by median arcuate ligament, elevation of liver function tests on the first postoperative day was noted. Endovascular stenting was performed on the same day with significant radiological improvement and subsequent normalization of laboratory values. The patient had no further postoperative complications. Conclusion: Fast recognition of ischemic complications after pancreatic head resection is crucial. Even postoperatively, endovascular intervention might be a feasible treatment modality of celiac axis stenosis in selected patients who undergo pancreatoduodenectomy.

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Celiac axis compression syndrome: laparoscopic approach in a strange case of chronic abdominal pain in 71 years old man

Open Medicine ◽

10.1515/med-2016-0049 ◽

2016 ◽

Vol 11 (1) ◽

pp. 248-251 ◽

Cited By ~ 3

Author(s):

Costantino Eretta ◽

Alessia Ferrarese ◽

Sonja Olcese ◽

Mikaela Imperatore ◽

Elisa Francone ◽

...

Keyword(s):

Abdominal Pain ◽

Young Patients ◽

Laparoscopic Approach ◽

Rare Condition ◽

Celiac Axis ◽

Median Arcuate Ligament ◽

Compression Syndrome ◽

Axis Compression ◽

Arcuate Ligament ◽

Celiac Axis Compression Syndrome

AbstractCeliac Axis Compression Syndrome by the Median Arcuate Ligament is a very rare condition characterized by chronic postprandial abdominal pain (angina abdominis), nausea, vomiting, which occurs mostly in young patients. The main treatment is a surgical procedure that consists of the division of the arcuate ligament combined with the section of the close diaphragmatic crus and the excision of the celiac plexus. Actually laparoscopic management is feasible and safe.

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