median arcuate ligament
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2022 ◽  
Vol 8 (1) ◽  
Author(s):  
Keita Hanada ◽  
Shigeru Tsunoda ◽  
Satoshi Ogiso ◽  
Tatsuto Nishigori ◽  
Shigeo Hisamori ◽  
...  

Abstract Background The celiac artery stenosis due to compression by median arcuate ligament (MAL) has been reported in many cases of pancreaticoduodenectomy, but not in cases of esophagectomy. Recently, the celiac artery stenosis due to MAL or arteriosclerosis has been reported to be associated with the gastric tube necrosis or anastomotic leakage following Ivor–Lewis esophagectomy. Herein, we present the first reported case of esophageal cancer with celiac artery stenosis due to compression by the MAL successfully treated by McKeown esophagectomy and gastric tube reconstruction following prophylactic MAL release. Case presentation A 72-year-old female patient was referred to our department for esophagectomy. The patient had received two courses of neoadjuvant chemotherapy with 5-FU and cisplatin for T2N0M0 squamous cell carcinoma of the middle esophagus. Preoperative contrast-enhanced computed tomography (CECT) showed celiac artery stenosis due to compression by the MAL. The development of collateral arteries around the pancreatic head was observed without evidence of aneurysm formation. The patient reported no abdominal symptoms. After robot-assisted esophagectomy with mediastinal lymphadenectomy, gastric mobilization, supra-pancreatic lymphadenectomy, and preparation of the gastric tube were performed under laparotomy. Subsequently, the MAL was cut, and released to expose the celiac artery. Improved celiac artery blood flow was confirmed by decreased pulsatility index on intraoperative Doppler sonography. The operation was completed with the cervical esophagogastric anastomosis following cervical lymphadenectomy. Postoperative CECT on postoperative day 7 demonstrated increased celiac artery patency. The patient had an uncomplicated postoperative course thereafter. Conclusions Prophylactic MAL release may be considered in patients with celiac artery stenosis due to compression by the MAL on preoperative CECT for esophagectomy.


2021 ◽  
Vol 54 (12) ◽  
pp. 901-908
Author(s):  
Taku Hattori ◽  
Satoru Takayama ◽  
Kohei Takura ◽  
Koshiro Harata ◽  
Masaki Sakamoto

Author(s):  
Joana Isabel Almeida ◽  
Margarida Nunes Coelho ◽  
Isabel Armas ◽  
Carlos Soares ◽  
Tatiana Santos ◽  
...  

2021 ◽  
Vol 7 (1) ◽  
Author(s):  
Yuki Takano ◽  
Shuichi Fujioka ◽  
Hironori Shozaki ◽  
Naoki Toya ◽  
Toru Ikegami

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.


Author(s):  
Thomas H. Shin ◽  
Bradley Rosinski ◽  
Andrew Strong ◽  
Hana Fayazzadeh ◽  
Alisan Fathalizadeh ◽  
...  

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