scholarly journals Hyperspectral Imaging (HSI)—A New Tool to Estimate the Perfusion of Upper Abdominal Organs during Pancreatoduodenectomy

Cancers ◽  
2021 ◽  
Vol 13 (11) ◽  
pp. 2846
Author(s):  
Yusef Moulla ◽  
Dorina Christin Buchloh ◽  
Hannes Köhler ◽  
Sebastian Rademacher ◽  
Timm Denecke ◽  
...  
Keyword(s):  
Hyperspectral Imaging ◽  
Invasive Procedure ◽  
Celiac Artery ◽  
Median Arcuate Ligament ◽  
Non Invasive ◽  
Abdominal Organs ◽  
Before And After ◽  
Arcuate Ligament ◽  
Tissue System ◽  
Upper Abdominal

Hyperspectral imaging (HSI) in abdominal surgery is a new non-invasive tool for the assessment of the perfusion and oxygenation of various tissues and organs. Its benefit in pancreatic surgery is still unknown. The aim of this study was to evaluate the key impact of using HSI during pancreatoduodenectomy (PD). In total, 20 consecutive patients were included. HSI was recorded during surgery as part of a pilot study approved by the local Ethics Committee. Data were collected prospectively with the TIVITA® Tissue System. Intraoperative HS images were recorded before and after gastroduodenal artery (GDA) clamping. We detected four patients with celiac artery stenosis (CAS) caused by a median arcuate ligament (MAL). In two of these patients, a reduction in liver oxygenation (StO2) was discovered 15 and 30 min after GDA clamping. The MAL was divided in these patients. HSI showed an improvement of liver StO2 after MAL division (from 61% to 73%) in one of these two patients. There was no obvious decrease in liver StO2 in the other two patients with CAS. HSI, as a non-invasive procedure, could be helpful in evaluating liver and gastric perfusion during PD, which might assist surgeons in choosing the best surgical approach and in improving patients’ outcomes.

scholarly journals Retroperitoneal Hematoma: Rupture of Aneurysm in the Arc of Bühler Caused by Median Arcuate Ligament Syndrome

2019 ◽  
Vol 12 ◽  
pp. 117954761982871
Author(s):  
Keiichiro Abe ◽  
Makoto Iijima ◽  
Keiichi Tominaga ◽  
Satoshi Masuyama ◽  
Naoya Izawa ◽  
...  
Keyword(s):  
Pancreatic Head ◽  
Celiac Artery ◽  
Sudden Onset ◽  
Aneurysm Rupture ◽  
Median Arcuate Ligament ◽  
Median Arcuate Ligament Syndrome ◽  
Abdominal Angiography ◽  
Arcuate Ligament ◽  
Upper Abdominal ◽  
The Right

We herein report a case with aneurysm rupture in the arc of Bühler (AOB) caused by median arcuate ligament syndrome (MALS). The patient experienced a sudden onset of upper abdominal pain. Contrast-enhanced abdominal computed tomography (CT) showed an iso- to hyper-enhancing area mainly ranging from the dorsal aspect of the pancreatic head to the retroperitoneum around the right kidney. Abdominal angiography revealed marked stenosis in the origin of the celiac artery caused by MALS and a 7-mm saccular aneurysm in the AOB. Thus, we diagnosed the pain as having been caused by aneurysm rupture in the AOB due to MALS. The patient’s symptoms and anemia also improved to normal range without surgery. Careful follow-up, considering possible recurrence of aneurysm at other sites in the future, is essential.

scholarly journals Median Arcuate Ligament Syndrome Clinical Presentation, Pathophysiology, and Management: Description of Four Cases

2021 ◽  
Vol 3 (1) ◽  
pp. 44-50
Author(s):  
Ihsan Al Bayati ◽  
Mahesh Gajendran ◽  
Brian R. Davis ◽  
Jesus R. Diaz ◽  
Richard W. McCallum
Keyword(s):  
Abdominal Pain ◽  
Celiac Artery ◽  
Definitive Treatment ◽  
Unknown Etiology ◽  
Symptom Presentation ◽  
Median Arcuate Ligament ◽  
Median Arcuate Ligament Syndrome ◽  
Long Term Follow Up ◽  
Arcuate Ligament ◽  
Upper Abdominal

Median arcuate ligament syndrome (MALS), otherwise called celiac artery compression syndrome (CACS), is an uncommon disorder that results from an anatomical compression of the celiac axis and/or celiac ganglion by the MAL. Patients typically present with abdominal pain of unknown etiology exacerbated by eating along with nausea, vomiting, and weight loss. MALS is a diagnosis of exclusion that should be considered in patients with severe upper abdominal pain, which does not correlate with the objective findings. The cardinal feature which is elicited in the diagnosis of MALS relies on imaging studies of the celiac artery, demonstrating narrowing during expiration. The definitive treatment is the median arcuate ligament’s surgical release to achieve surgical decompression of the celiac plexus by division of the MAL. This article describes our experience with this entity, focusing on symptom presentation, diagnostic challenges, and management, including long-term follow-up in four cases.

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.

Detailed anatomy and procedure of celiac artery decompression in median arcuate ligament syndrome

2021 ◽  
Author(s):  
Kyoji Ito ◽  
Nobuyuki Takemura ◽  
Ryo Oikawa ◽  
Fuyuki Inagaki ◽  
Fuminori Mihara ◽  
...  
Keyword(s):  
Celiac Artery ◽  
Median Arcuate Ligament ◽  
Median Arcuate Ligament Syndrome ◽  
Arcuate Ligament

Dunbar (Or Median Arcuate Ligament) Syndrome: A Case Series

2021 ◽  
Vol 23 (09) ◽  
pp. 450-459
Author(s):  
Dr Praveen K Sharma, MD RD ◽  
◽  
Dr. Pavankumar mathapati ◽  
Dr. Dinesh babu J ◽  
Dr. Keerthi vatsan ◽  
...  
Keyword(s):  
Case Series ◽  
Vascular Reconstruction ◽  
Vascular Compression ◽  
Median Arcuate Ligament ◽  
Median Arcuate Ligament Syndrome ◽  
Non Invasive ◽  
Compression Syndrome ◽  
Axis Compression ◽  
Arcuate Ligament ◽  
Dunbar Syndrome

Dunbar syndrome (DS) (or Median arcuate ligament syndrome) is a rare entity of the vascular compression syndrome, where there is focal proximal coeliac axis compression by Median arcuate ligament (MAL). It results in an insufficient supply of blood to the respective organs of the gastrointestinal tract (GIT). Multi-detector computed tomography (MDCT) is a very convenient non-invasive modality in diagnosing this condition and helpful in distinguishing it from other conditions, such as atherosclerotic disease. DS can further be treated disorder surgically by relieving the compression and sometimes may need vascular reconstruction. We present five cases of the DS.

scholarly journals A Case of Carcinoma of the Papilla of Vater Accompanied with a Stricture of the Celiac Artery by the Median Arcuate Ligament

2008 ◽  
Vol 41 (8) ◽  
pp. 1588-1593 ◽  
Author(s):  
Kiichiro Mogami ◽  
Toshiaki Ichihara ◽  
Tsutomu Sato ◽  
Satoshi Shibata ◽  
Tomokazu Takahashi ◽  
...  
Keyword(s):  
Celiac Artery ◽  
Papilla Of Vater ◽  
Median Arcuate Ligament ◽  
Arcuate Ligament

Assessment of celiac artery compression using color-coded duplex sonography

2020 ◽  
Vol 76 (3) ◽  
pp. 413-423 ◽  
Author(s):  
Claudia Römer ◽  
Thomas Fischer ◽  
Oliver Haase ◽  
Martin Möckel ◽  
Bernd Hamm ◽  
...  
Keyword(s):  
Diagnostic Performance ◽  
Peak Systolic Velocity ◽  
Rare Condition ◽  
Diagnostic Value ◽  
Celiac Artery ◽  
Breath Hold ◽  
Median Arcuate Ligament ◽  
Diagnostic Modality ◽  
Cross Sectional ◽  
Arcuate Ligament

BACKGROUND: Median arcuate ligament syndrome (MALS) is a rare condition due to compression of the celiac artery (CA) by an anatomically abnormal median arcuate ligament. With ultrasonography (US) as first-line diagnostic modality in patients with unclear abdominal pain, there is limited data on its diagnostic performance in MALS. OBJECTIVE: To investigate the value of CA peak systolic velocity (PSV) in the workup of patients with suspected MALS. METHODS: Patients with diagnosis of MALS between 2009 and 2019 were referred by Department of Visceral Surgery after clinical and gastroenterological workup. Diagnosis was confirmed by surgery or further cross-sectional imaging. B-mode US findings and PSV in the CA during various respiratory states were compared between patients with a final MALS diagnosis and patients not meeting the diagnostic criteria. RESULTS: Patients with proven MALS (n = 10) had higher median CA PSV during normal inspiratory breath-hold (239 [IQR, 159–327] vs. 138 [IQR, 116–152] cm/s; p < #x003C;< #x200A;0.001), and expiratory breath-hold (287 [IQR, 191–412] vs. 133 [IQR, 115–194] cm/s; p < #x003C;< #x200A;0.001) compared to patients without MALS (n = 26). CA PSV in both inspiratory breath-hold (AUC 0.88, 95% CI 0.77–1.00) and expiratory breath-hold (AUC 0.89, 95% CI 0.78–1.00) was of diagnostic value for confirming MALS. The best diagnostic performance (100% sensitivity, 80% specificity) was found for the combination of CA PSVexpiration + 2.4 · PSVinspiration > 550 cm/s . CONCLUSIONS: Since results on optimal cutoff values are inconsistent, a combination of CA PSVs during breathing maneuvers may help to diagnose or rule out MALS.

Median Arcuate Ligament Syndrome With Celiac Artery Aneurysm and Dissection

2020 ◽  
Vol 54 (6) ◽  
pp. 525-527
Author(s):  
Hans Michell ◽  
Nariman Nezami ◽  
Aaron Dewald ◽  
Anant Bhave ◽  
Christopher Morris ◽  
...  
Keyword(s):  
Artery Aneurysm ◽  
Celiac Artery ◽  
Artery Dissection ◽  
Median Arcuate Ligament ◽  
Median Arcuate Ligament Syndrome ◽  
Arcuate Ligament ◽  
Celiac Artery Aneurysm

Median arcuate ligament syndrome (MALS) is the chronic symptomatic compression of the celiac artery by the median arcuate ligament. A known potential sequela of MALS is celiac artery aneurysm, which could predispose the diseased artery to dissection. However, the presence of celiac artery dissection and MALS is yet to be reported. Here, we present a case of MALS with a coincident celiac artery aneurysm and dissection.

Compression of the Celiac Artery by the Median Arcuate Ligament: Multidetector Computed Tomography Findings and Characteristics

2015 ◽  
Vol 66 (3) ◽  
pp. 272-276 ◽  
Author(s):  
Ozdil Baskan ◽  
Emre Kaya ◽  
Fatma Zeynep Gungoren ◽  
Cengiz Erol
Keyword(s):  
Computed Tomography ◽  
Multidetector Computed Tomography ◽  
Dominant Role ◽  
Gastrointestinal Symptoms ◽  
Celiac Artery ◽  
Arterial Phase ◽  
Control Group ◽  
Median Arcuate Ligament ◽  
Arcuate Ligament ◽  
Atherosclerotic Changes

Purpose The prevalence of the celiac artery stenosis caused by median arcuate ligament (MAL) compression and its multidetector computed tomography (MDCT) characteristics were evaluated in patients who underwent abdominal MDCT procedures, retrospectively. Methods Totally 1121 patients who had abdominal MDCT with arterial phase or MDCT angiography of the abdominal aorta for various indications were analyzed for celiac artery compression by the MAL. Results Fifty (ie, 4.6%) patients showed typical MDCT features of MAL compression. Focal narrowing of the proximal celiac artery, a characteristic hooked appearance of the narrowed segment without calcification and atherosclerotic changes were diagnostic. Poststenotic dilatation was detected in 22 (44%) patients with MAL compression. The ratio of the stenosis of the celiac artery was between 35%-50% in 15 patients and 51%-80% in 35 patients. The gastroduodenal artery diameter of these patients was not significantly different from the asymptomatic control group. Conclusion MALS is an uncommon entity but it should be kept in mind in the presence of unexplained gastrointestinal symptoms. MDCT is a minimally invasive and plays a dominant role in the diagnosis of MAL compression especially with reformatted and 3-D reconstructed images.

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