scholarly journals Supraceliac aortic cross-clamping to control bleeding from the celiac axis during pancreatic surgery: a case report

2021 ◽  
Vol 7 (1) ◽  
Author(s):  
Yuki Takano ◽  
Shuichi Fujioka ◽  
Hironori Shozaki ◽  
Naoki Toya ◽  
Toru Ikegami
Keyword(s):  
Pancreatic Surgery ◽  
Arterial Wall ◽  
Pancreatic Head ◽  
Celiac Axis ◽  
Median Arcuate Ligament ◽  
Intraoperative Bleeding ◽  
Case Presentation ◽  
Arterial Bleeding ◽  
Abdominal Aortic ◽  
Arcuate Ligament

Abstract Background Intraoperative bleeding from the celiac axis (CA) can occur during pancreatic surgery, and appropriate management is essential to avoid critical complications. Here, we have reported a case that was managed with supraceliac aortic cross-clamping (SAC) for arterial bleeding from the CA during pancreatic surgery. Case presentation A 70-year-old man was diagnosed with pancreatic cancer located in the pancreatic head and body. Preoperative computed tomography showed a stricture at the root of the CA, which may have been caused by a median arcuate ligament. Pancreaticoduodenectomy with division of the median arcuate ligament was scheduled. Uncontrollable bleeding from the root of the CA was observed during surgery. The bleeding was controlled by performing SAC, and a defect in the CA was confirmed. Arterial wall repair was successfully performed under temporal blood control using SAC. The aortic clamp time was 2 min and 51 s, and the intraoperative blood loss was 480 ml. Conclusions Although SAC is primarily a procedure for ruptured abdominal aortic aneurysm, it can be useful for the management of CA injuries during pancreatic surgery.

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

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.

scholarly journals Laparoscopic treatment for celiac artery stenosis caused by median arcuate ligament compression with Adachi V type vascular anomaly: a case report

2021 ◽  
Vol 7 (1) ◽  
Author(s):  
Hiroshi Saito ◽  
Koichiro Sawada ◽  
Jyunichi Ogawa ◽  
Masashi Hashimoto ◽  
Masahiro Oshima ◽  
...  
Keyword(s):  
Epigastric Pain ◽  
Vascular Anomaly ◽  
Celiac Artery ◽  
Artery Stenosis ◽  
Laparoscopic Treatment ◽  
Median Arcuate Ligament ◽  
Case Presentation ◽  
Arcuate Ligament ◽  
Major Vascular Injury

Abstract Background Median arcuate ligament syndrome (MALS), which results from compression of the median arcuate ligament (MAL), is a rare cause of abdominal pain and weight loss. Treatment is dissection of the MAL; however, the laparoscopic procedure is not yet established and it involves the risk of major vascular injury, especially in cases with an anomaly. Case presentation A 47-year-old man was evaluated at the hospital for epigastric pain. Contrast computed tomography scan revealed stenosis of the celiac artery origin due to the MAL. An Adachi V type vascular anomaly was also observed. Laparoscopic treatment was performed to release pressure on the celiac artery. Laparoscopic ultrasonography was used to less invasively confirm the release of the MAL. Despite a concomitant Adachi V type vascular anomaly, surgery was safely performed using the laparoscopic magnification view and intraoperative ultrasonography. Follow-up ultrasonography confirmed the celiac artery stenosis has not recurred. Conclusions A rare case of MALS with an Adachi V type vascular anomaly is presented and the laparoscopic treatment is detailed.

scholarly journals Management of median arcuate ligament syndrome in patients who require pancreaticoduodenectomy

2011 ◽  
Vol 93 (4) ◽  
pp. e11-e14 ◽  
Author(s):  
Robert N Whistance ◽  
Vallari Shah ◽  
Emily R Grist ◽  
Clifford P Shearman ◽  
Neil W Pearce ◽  
...  
Keyword(s):  
Pancreatic Head ◽  
Biliary Tree ◽  
Vascular Reconstruction ◽  
Artery Occlusion ◽  
Gastroduodenal Artery ◽  
Median Arcuate Ligament ◽  
Cross Sectional ◽  
Coeliac Artery ◽  
Vascular Insufficiency ◽  
Arcuate Ligament

Pancreaticoduodenectomy is the standard treatment for localised neoplasms of the pancreatic head. The operation can be performed safely in specialist units but good outcome is compromised if postoperative blood flow to the liver and biliary tree is inadequate. Coeliac artery occlusion with blood supply to the liver arising from the superior mesenteric artery via the gastroduodenal artery is difficult to recognise, especially intraoperatively. Recognition of absent hepatic artery pulsation after occlusion of the gastroduodenal artery opens a dilemma: should the resection be abandoned or should vascular reconstruction be undertaken, adding risk to an already complex procedure? We describe two cases with a resectable pancreatic endocrine tumour in which coeliac artery occlusion caused by median arcuate ligament compression was identified from cross-sectional imaging and reconstructions. We highlight two different strategies to correct the vascular insufficiency and allow safe pancreatic resection.

scholarly journals Median Arcuate Ligament Syndrome: A Case Report

2018 ◽  
Vol 21 (2) ◽  
pp. 38-39
Author(s):  
Akash Chitrakar ◽  
Nirajan Subedi ◽  
Ramesh Singh Bhandari
Keyword(s):  
Computed Tomography ◽  
Case Report ◽  
Epigastric Pain ◽  
Celiac Artery ◽  
Celiac Axis ◽  
Median Arcuate Ligament ◽  
Median Arcuate Ligament Syndrome ◽  
Celiac Ganglion ◽  
Extrinsic Compression ◽  
Arcuate Ligament

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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