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.

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

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

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

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.

Síndrome do Ligamento Arqueado Mediano - Relato de Caso/ Median Arcuate Ligament Syndrome – Case Report

1970 ◽  
Vol 3 (1) ◽  
pp. 67-76
Author(s):  
Leandro Urquiza Marques Alves Da Silva ◽  
Rodrigo Ribeiro Tiengo
Keyword(s):  
Abdominal Pain ◽  
Case Report ◽  
Multislice Ct ◽  
Celiac Trunk ◽  
Chronic Abdominal Pain ◽  
Vascular Compression ◽  
Imaging Findings ◽  
Median Arcuate Ligament ◽  
Median Arcuate Ligament Syndrome ◽  
Arcuate Ligament

Introdução: A Síndrome do Ligamento Arqueado Mediano, também denominada Síndrome da Compressão do Tronco Celíaco decorre da compressão do Tronco Celíaco pelo ligamento Arqueado Mediano, comprometendo o fluxo sanguíneo e causando sintomas. O grau de compressão varia com as fases do ciclo respiratório, devido a mobilidade das estruturas, sendo maior na expiração. Casuística: O trabalho relata o caso de uma paciente com quadro de dor abdominal crônica, mal definida, há cerca de 25 anos. Os sintomas eram desencadeados pela ingestão de alimentos. Foram realizados exames de imagem para investigação diagnóstica que demonstraram alterações típicas da compressão do Tronco Celíaco pelo Ligamento Arqueado Mediano, como o aspecto em “gancho” na angiotomografia multislice do abdome e aumento das velocidades sistólica e diastólica, no estudo ultrassonográfico com Doppler. Discussão: Diante do quadro clínico apresentado pela paciente, estabeleceu-se o diagnóstico da Síndrome do Ligamento Arqueado Mediano, caracterizada pelos achados imagenológicos citados, associados aos sintomas de dor abdominal crônica, mal definida, geralmente desencadeada pela alimentação. Os estudos de imagem também permitiram a exclusão de outras patologias que poderiam ser a causa das dores da paciente. Conclusão: Os achados de imagem são fundamentais para o diagnóstico da síndrome, pois quando presentes têm alta especificidade e ainda podem excluir outras condições que poderiam causar dor abdominal crônica. O tratamento consiste na secção do ligamento, sua indicação ainda permanece controversa na literatura.Palavras chave: Ligamento Arqueado Mediano, tronco celíaco, compressão vascular.ABSTRACTIntroduction: The Median Arcuate Ligament Syndrome, also called Syndrome Compression of the results from of Celiac Trunk compression by the ligament Arched Median, compromising blood flow and causing symptoms. The degree of compression varies with the phases of the respiratory cycle, because of the mobility of the structures, being greater during expiration. Case report: The case reports a history of a patient with chronic abdominal pain, ill-defined, about 25 years. The symptoms were triggered by the ingestion of food .Performed imaging exams that showed changes typical of compression of the Celiac Trunk by Median arcuate ligament, as the appearance of "hook" on multislice CT angiography of the abdomen and increase in systolic and diastolic velocities at Doppler ultrasonographic examinations. Discussion: Given the clinical history presented by the patient, we established the diagnosis of Median Arcuate Ligament Syndrome, characterized by the above imaging findings and symptoms associated with chronic abdominal pain, ill-defined, usually triggered by food. Imaging studies also allowed the exclusion of other pathologies that could be the cause of the patient’s pain. Conclusion: The imaging findings are essential for the diagnosis of the syndrome, because they have high specificity and can still rule out other conditions that could cause abdominal pain chronic. The treatment consists in section of the ligament, its indication is still controversial in literature. Key words: Arcuate ligament, celiac trunk, vascular compression 

scholarly journals Surgical treatment of median arcuate ligament syndrome: Case report and review of literature

2015 ◽  
Vol 143 (1-2) ◽  
pp. 74-78 ◽  
Author(s):  
Milutin Kotarac ◽  
Nebojsa Radovanovic ◽  
Nebojsa Lekic ◽  
Zoran Raznatovic ◽  
Vladimir Djordjevic ◽  
...  
Keyword(s):  
Weight Loss ◽  
Surgical Treatment ◽  
Initial Segment ◽  
Epigastric Pain ◽  
Celiac Trunk ◽  
Celiac Artery ◽  
Pathophysiological Mechanism ◽  
Selective Angiography ◽  
Median Arcuate Ligament ◽  
Arcuate Ligament

Introduction. Median arcuate ligament (MAL) syndrome, also called celiac trunk compression syndrome (CACS) or Dunbar syndrome is a rare disorder caused by compression of the celiac artery by median arcuate ligament of the diaphragm, which leads to mesenteric ischemia and chronic abdominal angina. The typical clinical triad of symptoms includes postprandial epigastric pain, weight loss and vomiting. The gold standard for MAL syndrome diagnosis is selective angiography, while in symptomatic patients with angiographically verified stenosis the optimal therapy is surgical treatment. Case Outline. A 40-year-old male patient was presented with epigastric pain, followed by dyspepsia and weight loss. The upper endoscopy showed gastric and duodenal distention with prominent folds of gastric mucosa and slow peristalsis. Selective angiography showed stenosis (90%) of initial segment of the celiac trunk. Adhesiolysis with the transection of the median arcuate ligament was performed. Due to repeated symptoms, the patient was reoperated on the 10th postoperative day with performed adhesiolysis and gastrostomy for gastric nutrition. Two months later, the patient was rehospitalized for closure of gastrostomy. At five years follow-up, selective angiography showed no stenosis of the initial segment of the celiac artery. Conclusion. Despite the existing controversy concerning pathophysiological mechanism, the clinical presentation and treatment modalities of patients with MAL syndrome, it is evident that careful selection and adequate surgical treatment may significantly reduce symptoms in these patients.

scholarly journals Effectiveness of mebeverine in patients with post-cholecystectomy gastrointestinal spasm: results of prospective observational program “odyssey”

2018 ◽  
Vol 90 (8) ◽  
pp. 40-47 ◽  
Author(s):  
I V Maev ◽  
Yu A Kucheravy ◽  
V V Tsukanov ◽  
E Yu Eremnia ◽  
D N Andreev ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Abdominal Pain ◽  
Surgical Treatment ◽  
Rating Scale ◽  
Clinical Symptoms ◽  
Gastrointestinal Symptoms ◽  
Marked Change ◽  
Numeric Rating Scale ◽  
Observational Assessment

Aim: to assess the effectiveness of mebeverine 200 mg BID in patients with post-cholecystectomy gastrointestinal spasm not requiring surgical treatment. Materials and methods. 218 patients were included in 16 clinical centers in 14 cities in Russia. All patients had post-cholecystectomy gastrointestinal spasms, not requiring surgical treatment and received mebeverine (Duspatalin®) 200 mg BID. The observational assessment period lasted from the moment of their inclusion into the study up to 6 weeks post inlusion. The therapy results were evaluated using visual analog scales (GPA and 11-point numeric rating scale) by patient self-assessment of the dynamics of spasm/discomfort and other post-cholecystectomic gastrointestinal symptoms after 2 and 6 weeks of treatment. Gastrointestinal Quality of Life Index (GIQLI) was used to assess patient quality of life. Results and discussion. All 218 patients completed the 2-week mebeverine treatment course, 101 of them finished the 6-week course (“prolonged population”). Significant positive changes in the relief of abdominal pain and dyspepsia were noted as well as normalization of stool frequency and consistency. A more marked change in values was observed during prolonged (up to 6 weeks) therapy. Both 2-week and 6-week mebeverine courses led to a normalization of patient quality of life. After 6 week therapy, an effect of mebeverine on the quality of life 91% of patients was observed comparable to cholecystectomy itself, speficially related to the quality of life subscore ‘symptoms’. Conclusion. The results of our study demonstrate that mebeverine (Duspatalin®) therapy leads to an effective elimination of clinical symptoms associated with post-cholecystectomy GI-spasm disorders, like abdominal pain, symptoms of dyspepsia and stooldisorders. A more marked change in values was observed during prolonged (up to 6 weeks) therapy.

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

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.

2762 Median Arcuate Ligament Syndrome: A Rare but Overlooked Cause of Post-Prandial Abdominal Pain

2019 ◽  
Vol 114 (1) ◽  
pp. S1526-S1527
Author(s):  
Hussam Tayel ◽  
Hesham Tayel ◽  
Sagar V. Mehta ◽  
Rodrigo Duarte-Chavez ◽  
Brian Kim ◽  
...  
Keyword(s):  
Abdominal Pain ◽  
Median Arcuate Ligament ◽  
Median Arcuate Ligament Syndrome ◽  
Arcuate Ligament
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