scholarly journals Laparoscopic therapy of the coeliac artery compression syndrome: a critical analysis of the current standard procedure

2020 ◽  
Vol 102 (2) ◽  
pp. 104-109 ◽  
Author(s):  
M Sahm ◽  
R Otto ◽  
M Pross ◽  
T Scholbach ◽  
R Mantke
Keyword(s):  
Flow Velocity ◽  
Doppler Ultrasonography ◽  
Clinical Symptoms ◽  
Standard Procedure ◽  
Symptomatic Relief ◽  
Current Standard ◽  
Median Arcuate Ligament ◽  
Coeliac Artery ◽  
Arcuate Ligament

Introduction Median arcuate ligament syndrome has been known anatomically for approximately 100 years and results from a compression of the coeliac axis by fibrous attachment of the diaphragmatic crura. Owing to the rarity of the disease and limited available data, many aspects of treatment are controversial. Currently, laparoscopic decompression is considered by several authors as standard surgical procedure. We present an analysis of the clinical routine of MALS therapy. Methods We conducted a prospective observational trial in patients with MALS between March 2016 and August 2018, in which clinical symptoms, diagnostic evaluation, procedures with complication analysis and follow-up data were recorded. Results A total of 18 patients (12 female, 6 male) with MALS, aged between 15 and 65 years, were included in this study. All patients presented with long-standing abdominal pain. Preoperative Doppler ultrasonography showed a flow velocity of the coeliac artery averaging 289.9cm/second in mid-position of the diaphragm, 285.9cm/second in expiration and 199.0cm/second in inspiration. All operated patients underwent laparoscopic decompression; two patients received an angiographic intervention. Postoperatively, a significant decrease of the flow velocity in mid-position of the diaphragm was detected (P = 0.018). At follow-up after 5.2 months, 50.0% of the patients were pain-free, 37.5% reported symptomatic relief and 12.5% showed evidence for a recurrence. Conclusion MALS is challenging both diagnostically and therapeutically. Laparoscopy with release of the median arcuate ligament is an essential part of the therapy and can be confirmed by Doppler ultrasonography. Disease outcome is also influenced by several predictive factors.

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.

Median arcuate ligament syndrome: vascular surgical therapy and follow-up of 18 patients

2009 ◽  
Vol 394 (6) ◽  
pp. 1085-1092 ◽  
Author(s):  
Dirk Grotemeyer ◽  
Mansur Duran ◽  
Franziska Iskandar ◽  
Dirk Blondin ◽  
Kim Nguyen ◽  
...  
Keyword(s):  
Surgical Therapy ◽  
Median Arcuate Ligament ◽  
Median Arcuate Ligament Syndrome ◽  
Arcuate Ligament

scholarly journals Laparoscopic dissection in children with celiac artery compression syndrome

2021 ◽  
Vol 11 (2) ◽  
pp. 131-140
Author(s):  
Razhab A. Zainulabidov ◽  
Alexander Y. Razumovsky ◽  
Zorikto B. Mitupov ◽  
Galina Y. Chumakova
Keyword(s):  
Abdominal Pain ◽  
Surgical Treatment ◽  
Clinical Symptoms ◽  
Abdominal Cavity ◽  
Treatment Success ◽  
Celiac Trunk ◽  
Early Postoperative Period ◽  
Median Arcuate Ligament ◽  
Flow Measurements ◽  
Arcuate Ligament

BACKGROUND: A cause of abdominal pain in children may be compression stenosis of the celiac trunk (Dunbars syndrome). This disease occurs when the median arcuate ligament of the diaphragm compresses the celiac trunk, thereby creating compression stenosis, causing the arterial hemodynamics in the artery to suffer and provide adequate blood circulation to the abdominal cavity organs. Medical statistics indicate that 10% to 15% of children and adolescents suffering from chronic abdominal pain have compression stenosis of the celiac trunk. AIM: This study aims to improve the diagnostic results and identify the indications for the surgical treatment of children with compression stenosis of the celiac trunk. MATERIALS AND METHODS: From 2015 to 2020 at the N.F. Filatov Childrens Hospital, 64 patients, aged 4 to 17 years underwent surgical treatment for compression stenosis of the celiac trunk. There are 42 boys (66%) and 22 girls (34%). The leading clinical manifestation in all patients was abdominal pain. Associated surgical pathology was observed in 34 of them. The diagnosis was based on anamnesis, examination, ultrasound examination with Doppler and celiac trunk blood flow measurements, multispiral computed tomography, and angiography. RESULTS: After completing the examination, 61 patients underwent laparoscopic decompression of the celiac trunk, and three children were operated on using the laparotomic approach. In all cases, the leading cause of compression stenosis of the celiac trunk was the median arcuate ligament of the diaphragm combined with the neurofibrous tissue of the celiac plexus. The average duration of the operation was 50 minutes. Intraoperative blood loss did not exceed 530 ml. One conversion completed. There were no postoperative complications in the early postoperative period. The patients were discharged in satisfactory condition. The control examination was conducted in the period from six months to three years. In 97% of patients, clinical symptoms of abdominal ischemia were not detected. CONCLUSION: Our experience indicates the possibility of diagnosing compression stenosis of the celiac trunk in children at early disease stages and laparoscopic treatment success of patients with this disease.

scholarly journals Resection and reconstruction of pancreatic artery aneurysms caused by the compression of the celiac trunk by the median arcuate ligament: a report of two cases

2021 ◽  
Vol 7 (1) ◽  
Author(s):  
Hideaki Uchiyama ◽  
Sosei Kuma ◽  
Mayumi Ishida ◽  
Eiji Tsujita ◽  
Yoshinari Nobuto ◽  
...  
Keyword(s):  
Blood Flow ◽  
Celiac Trunk ◽  
Arterial Blood Flow ◽  
Median Arcuate Ligament ◽  
Contrast Enhanced Ct ◽  
Contrast Enhanced ◽  
Enhanced Ct ◽  
Pancreatic Artery ◽  
Arcuate Ligament

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.

scholarly journals Morvan syndrome associated with LGI1 antibody: a case report

BMC Neurology ◽  
2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Shui-Jing Zhang ◽  
Yan-Yan Xue ◽  
Hao Yu ◽  
Qing-Qing Tao
Keyword(s):  
Clinical Symptoms ◽  
Symptomatic Relief ◽  
Oral Prednisone ◽  
Intravenous Methylprednisolone ◽  
Limb Pain ◽  
Case Presentation ◽  
Autoimmune Syndrome ◽  
Insomnia Symptoms ◽  
Medical Side

Abstract Background Morvan syndrome (MoS) is a rare autoimmune syndrome associated with antibodies against two kinds of potassium channel proteins, contactin associated protein-like 2 (CASPR2) and leucine-rich glioma inactivated protein 1 (LGI1). MoS patients with only LGI1-antibody seropositivity have rarely been reported. Here, we describe a 64-year-old male MoS patient with only LGI1-antibody seropositivity. Case presentation A 64-year-old male patient was referred to our hospital due to limb pain, widespread myokymia, insomnia, constipation, and hyperhidrosis for 1 month. The patient was diagnosed with MoS based on the clinical symptoms and positive LGI1-antibody in serum. He was treated with intravenous immunoglobulin (IVIG), intravenous methylprednisolone followed by oral prednisone, and other drugs for symptomatic relief. Several days later, myokymia and insomnia symptoms improved. After 60 days of follow-up, all the drugs had been stopped for 2 weeks, and the patient achieved complete remission without any medical side effects. Conclusion We report the clinical characteristics of a Chinese MoS patient with only LGI1-antibody seropositivity, and further support the view that non-neoplasm MoS patients respond well to immunotherapy.

Sign in / Sign up

Export Citation Format

Share Document