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Yadav P, Acharya K, Adhikari AB, Yadav M, Adhikari A, Sah OP. Median arcuate ligament syndrome: A rare case report from Nepal. Int J Surg Case Rep 2024; 120:109809. [PMID: 38796938 PMCID: PMC11152655 DOI: 10.1016/j.ijscr.2024.109809] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2024] [Revised: 05/17/2024] [Accepted: 05/22/2024] [Indexed: 05/29/2024] Open
Abstract
INTRODUCTION Median arcuate ligament syndrome (MALS) is a rare condition caused by the compression of the celiac trunk by the median arcuate ligament, leading to a typical symptom triad: postprandial abdominal pain, weight loss, nausea, and vomiting. CASE PRESENTATION A 41-year-old female patient presented to our center with mild postprandial abdominal pain over the epigastric region, and bloating sensation. Ultrasonography of the abdomen showed multiple stones in the gall bladder lumen, and the computed tomography scan showed median arcuate ligament impingement along the proximal aspect of the celiac trunk causing moderate narrowing with post-stenotic dilation. Laparoscopic release of the median arcuate ligament with laparoscopic cholecystectomy was performed. DISCUSSION The diagnosis of Median Arcuate Ligament Syndrome is based on the classical post-prandial symptoms and abdominal imaging technologies like Doppler ultrasonography, computed tomography angiography, or magnetic resonance angiography. Exclusion of other intestinal disorders should be considered before making the diagnosis. Celiac artery decompression through different means is the principle of treatment of this condition. CONCLUSION The diagnosis of median arcuate ligament syndrome should be considered in patients with postprandial abdominal pain that does not have an established etiology. Celiac artery decompression by releasing the median arcuate ligament is the treatment.
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Affiliation(s)
- Prashant Yadav
- Kathmandu Medical College and Teaching Hospital, Sinamangal, Kathmandu, Nepal.
| | - Kshitiz Acharya
- Maharajgunj Medical Campus, Tribhuvan University Institute of Medicine, Kathmandu, Nepal
| | - Aramva Bikram Adhikari
- Maharajgunj Medical Campus, Tribhuvan University Institute of Medicine, Kathmandu, Nepal
| | - Manish Yadav
- Maharajgunj Medical Campus, Tribhuvan University Institute of Medicine, Kathmandu, Nepal
| | - Aayam Adhikari
- Kist Medical College and Teaching Hospital, Lalitpur, Nepal
| | - Om Prakash Sah
- Kathmandu Medical College and Teaching Hospital, Sinamangal, Kathmandu, Nepal
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Median Arcuate Ligament Syndrome Clinical Presentation, Pathophysiology, and Management: Description of Four Cases. GASTROINTESTINAL DISORDERS 2021. [DOI: 10.3390/gidisord3010005] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/15/2023] Open
Abstract
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.
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Farina R, Foti PV, Conti A, Iannace FA, Pennisi I, Fanzone L, Inì C, Libra F, Vacirca F, Failla G, Baldanza D, Palmucci S, Santonocito S, Basile A. The role of ultrasound imaging in vascular compression syndromes. Ultrasound J 2021; 13:4. [PMID: 33555480 PMCID: PMC7870731 DOI: 10.1186/s13089-020-00202-6] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2020] [Accepted: 12/14/2020] [Indexed: 11/24/2022] Open
Abstract
Vascular compression syndromes are rare alterations that have in common the compression of an arterial and/or venous vessel by contiguous structures and can be congenital or acquired. The best known are the Thoracic Outlet Syndrome, Nutcracker Syndrome, May–Thurner Syndrome, and Dunbar Syndrome. The incidence of these pathologies is certainly underestimated due to the non-specific clinical signs and their frequent asymptomaticity. Being a first-level method, Ultrasound plays a very important role in identifying these alterations, almost always allowing a complete diagnostic classification. If in expert hands, this method can significantly contribute to the reduction of false negatives, especially in the asymptomatic population, where the finding of the aforementioned pathologies often happens randomly following routine checks. In this review, we briefly discuss the best known vascular changes, the corresponding ultrasound anatomy, and typical ultrasound patterns.
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Affiliation(s)
- Renato Farina
- Radiodiagnostic and Radiotherapy Unit, Department of Medical and Surgical Sciences and Advanced Technologies "GF Ingrassia", Via Santa Sofia 78, 95123, Catani, Italy.
| | - Pietro Valerio Foti
- Radiodiagnostic and Radiotherapy Unit, Department of Medical and Surgical Sciences and Advanced Technologies "GF Ingrassia", Via Santa Sofia 78, 95123, Catani, Italy
| | - Andrea Conti
- Radiodiagnostic and Radiotherapy Unit, Department of Medical and Surgical Sciences and Advanced Technologies "GF Ingrassia", Via Santa Sofia 78, 95123, Catani, Italy
| | - Francesco Aldo Iannace
- Radiodiagnostic and Radiotherapy Unit, Department of Medical and Surgical Sciences and Advanced Technologies "GF Ingrassia", Via Santa Sofia 78, 95123, Catani, Italy
| | - Isabella Pennisi
- Radiodiagnostic and Radiotherapy Unit, Department of Medical and Surgical Sciences and Advanced Technologies "GF Ingrassia", Via Santa Sofia 78, 95123, Catani, Italy
| | - Luigi Fanzone
- Radiodiagnostic and Radiotherapy Unit, Department of Medical and Surgical Sciences and Advanced Technologies "GF Ingrassia", Via Santa Sofia 78, 95123, Catani, Italy
| | - Corrado Inì
- Radiodiagnostic and Radiotherapy Unit, Department of Medical and Surgical Sciences and Advanced Technologies "GF Ingrassia", Via Santa Sofia 78, 95123, Catani, Italy
| | - Federica Libra
- Radiodiagnostic and Radiotherapy Unit, Department of Medical and Surgical Sciences and Advanced Technologies "GF Ingrassia", Via Santa Sofia 78, 95123, Catani, Italy
| | - Francesco Vacirca
- Radiodiagnostic and Radiotherapy Unit, Department of Medical and Surgical Sciences and Advanced Technologies "GF Ingrassia", Via Santa Sofia 78, 95123, Catani, Italy
| | - Giovanni Failla
- Radiodiagnostic and Radiotherapy Unit, Department of Medical and Surgical Sciences and Advanced Technologies "GF Ingrassia", Via Santa Sofia 78, 95123, Catani, Italy
| | - Davide Baldanza
- Radiodiagnostic and Radiotherapy Unit, Department of Medical and Surgical Sciences and Advanced Technologies "GF Ingrassia", Via Santa Sofia 78, 95123, Catani, Italy
| | - Stefano Palmucci
- Radiodiagnostic and Radiotherapy Unit, Department of Medical and Surgical Sciences and Advanced Technologies "GF Ingrassia", Via Santa Sofia 78, 95123, Catani, Italy
| | - Serafino Santonocito
- Radiodiagnostic and Radiotherapy Unit, Department of Medical and Surgical Sciences and Advanced Technologies "GF Ingrassia", Via Santa Sofia 78, 95123, Catani, Italy
| | - Antonio Basile
- Radiodiagnostic and Radiotherapy Unit, Department of Medical and Surgical Sciences and Advanced Technologies "GF Ingrassia", Via Santa Sofia 78, 95123, Catani, Italy
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Farina R, Foti PV, Conti A, Iannace FA, Pennisi I, Santonocito S, Fanzone L, Mazzone G, Palmucci S, Basile A. The Role of Ultrasound in Dunbar Syndrome: Lessons Based on a Case Report. Am J Case Rep 2020; 21:e926778. [PMID: 33161411 PMCID: PMC7656089 DOI: 10.12659/ajcr.926778] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
Patient: Male, 55-year-old Final Diagnosis: Dunbar syndrome Symptoms: Epigastric pain • weight loss Medication: — Clinical Procedure: None Specialty: Gastroenterology and Hepatology • Radiology
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Affiliation(s)
- Renato Farina
- Radiodiagnostic and Radiotherapy Unit, Department of Medical and Surgical Sciences and Advanced Technologies "GF Ingrassia", Catania University, Catania, Italy
| | - Pietro Valerio Foti
- Radiodiagnostic and Radiotherapy Unit, Department of Medical and Surgical Sciences and Advanced Technologies "GF Ingrassia", Catania University, Catania, Italy
| | - Andrea Conti
- Radiodiagnostic and Radiotherapy Unit, Department of Medical and Surgical Sciences and Advanced Technologies "GF Ingrassia", Catania University, Catania, Italy
| | - Francesco Aldo Iannace
- Radiodiagnostic and Radiotherapy Unit, Department of Medical and Surgical Sciences and Advanced Technologies "GF Ingrassia", Catania University, Catania, Italy
| | - Isabella Pennisi
- Radiodiagnostic and Radiotherapy Unit, Department of Medical and Surgical Sciences and Advanced Technologies "GF Ingrassia", Catania University, Catania, Italy
| | - Serafino Santonocito
- Radiodiagnostic and Radiotherapy Unit, Department of Medical and Surgical Sciences and Advanced Technologies "GF Ingrassia", Catania University, Catania, Italy
| | - Luigi Fanzone
- Radiodiagnostic and Radiotherapy Unit, Department of Medical and Surgical Sciences and Advanced Technologies "GF Ingrassia", Catania University, Catania, Italy
| | - Giuseppe Mazzone
- Radiodiagnostic and Radiotherapy Unit, Department of Medical and Surgical Sciences and Advanced Technologies "GF Ingrassia", Catania University, Catania, Italy
| | - Stefano Palmucci
- Radiodiagnostic and Radiotherapy Unit, Department of Medical and Surgical Sciences and Advanced Technologies "GF Ingrassia", Catania University, Catania, Italy
| | - Antonio Basile
- Radiodiagnostic and Radiotherapy Unit, Department of Medical and Surgical Sciences and Advanced Technologies "GF Ingrassia", Catania University, Catania, Italy
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San Norberto EM, Romero A, Fidalgo-Domingos LA, García-Saiz I, Taylor J, Vaquero C. Laparoscopic treatment of median arcuate ligament syndrome: a systematic review. INT ANGIOL 2019; 38:474-483. [PMID: 31580040 DOI: 10.23736/s0392-9590.19.04161-0] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
INTRODUCTION Median arcuate ligament syndrome (MALS) is an uncommon condition caused by the extrinsic compression of the celiac trunk (CT) and celiac ganglion, secondary to an anatomical abnormality of the median arcuate ligament fibers. It is characterized by postprandial epigastric pain, chronic abdominal pain, weight loss, nausea and vomiting. MALS is typically diagnosed after the exclusion of other, more common conditions; however, a variety of imaging and diagnostic modalities, including Duplex ultrasonography, computed tomography angiography, magnetic resonance angiography, gastric tonometry and angiography can suggest findings consistent with MALS. EVIDENCE ACQUISITION Laparoscopic approach has been proposed as the option of choice for the treatment of these patients. A systematic review of the international literature regarding this modality of treatment is presented here. EVIDENCE SYNTHESIS The review included 504 cases, and several principles are suggested to improve the management. The advantages of this minimally invasive technique include short operative time (136.0 minutes, range 70-242), shorter hospital stay (3.8 days, range 0.5-7) and low rate of conversion to open surgery (4.2%). CONCLUSIONS Various treatment modalities are available to decompress the celiac trunk. Although open surgery has been traditionally accepted as the gold standard, laparoscopic division of the MALS has proven equal results. Others have described different treatment modalities, including bypass surgery and endovascular procedures (angioplasty or stent placement). Laparoscopic approaches to correct MALS are feasible and safe. It may be the preferred modality of treatment in view of its lack of morbidity, shorter hospital stay and good results.
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Affiliation(s)
| | - Alejandro Romero
- Department of General Surgery, Valladolid University Hospital, Valladolid, Spain
| | | | - Irene García-Saiz
- Department of Anesthesia and Critical Care, Rio Hortega University Hospital, Valladolid, Spain
| | - James Taylor
- Department of Cardiac Surgery, Valencia General University Hospital, Valencia, Spain
| | - Carlos Vaquero
- Department Vascular Surgery, Valladolid University Hospital, Valladolid, Spain
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Abstract
Median arcuate ligament syndrome (MALS) refers to a clinical syndrome caused by compression of the median arcuate ligament due to the fibers of this ligament that connect the diaphragmatic crura on the two sides of the aortic foramina, forming the anterior edge of the aortic foramina. If MALS is suspected, invasive digital subtraction angiography and computed tomography angiography or magnetic resonance angiography (MRA) can be used to verify the location of the celiac trunk. A disrupted or increased blood flow in the proximal end of the celiac trunk can be detected with doppler ultrasound, indicating stenosis. Treatment needs to alleviate celiac trunk compression. A common procedure involves separation of the ligament fibers and other surrounding tissues around the beginning of the celiac trunk. This can be achieved by either laparotomy or laparoscopic surgery. Patient prognosis is good, with a cure rate of about 80%.
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Affiliation(s)
- Zhipeng Sun
- General Surgery Department, Peking University Ninth School of Clinical Medicine (Beijing Shijitan Hospital, Capital Medical University), Beijing, China
| | - Dongdong Zhang
- General Surgery Department, Peking University Ninth School of Clinical Medicine (Beijing Shijitan Hospital, Capital Medical University), Beijing, China
| | - Guangzhong Xu
- General Surgery Department, Peking University Ninth School of Clinical Medicine (Beijing Shijitan Hospital, Capital Medical University), Beijing, China
| | - Nengwei Zhang
- General Surgery Department, Peking University Ninth School of Clinical Medicine (Beijing Shijitan Hospital, Capital Medical University), Beijing, China
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Ho KKF, Walker P, Smithers BM, Foster W, Nathanson L, O'Rourke N, Shaw I, McGahan T. Outcome predictors in median arcuate ligament syndrome. J Vasc Surg 2017; 65:1745-1752. [DOI: 10.1016/j.jvs.2016.11.040] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2016] [Accepted: 11/16/2016] [Indexed: 10/20/2022]
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Celiac artery compression of patients undergoing pancreatic surgery – a case series. Eur Surg 2016. [DOI: 10.1007/s10353-016-0443-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Sempere Ortega C, Gallego Rivera I, Shahin M. Gastric ischaemia as an unusual presentation of median arcuate ligament compression syndrome. BJR Case Rep 2016; 3:20160005. [PMID: 30363266 PMCID: PMC6159279 DOI: 10.1259/bjrcr.20160005] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2015] [Accepted: 06/27/2016] [Indexed: 12/29/2022] Open
Abstract
Median arcuate ligament compression syndrome is an anatomical and clinical entity defined by a combination of extrinsic compression of the coeliac axis by the median arcuate ligament and clinical manifestations. The majority of patients with features of compression experience no symptoms. The most common clinical symptoms when present are epigastric pain, nausea, vomiting and weight loss. Hypertrophy of the median arcuate ligament is a rare cause of chronic abdominal pain. We present a case of an elderly male patient who presented with acute epigastric pain, and gastric and intrahepatic portal pneumatosis on CT imaging. Emphysematous gastritis, caustic ingestion and other causes of this imaging presentation were ruled out. Imaging also showed chronic compression of the coeliac axis with compensatory hypertrophy of the gastroduodenal artery. Gastric ischaemia is a rare presentation of this syndrome, which occurs owing to the failure of compensatory mechanisms and resultant ischaemic injury to a virtual watershed vascular territory of the gastric wall. Conservative management was performed, including volume restoration, intravenous proton pump inhibitor therapy, broad-spectrum antibiotic therapy and blood transfusion. No surgical or endovascular interventional procedures were carried out. The patient showed clinical improvement soon after the initiation of treatment. Disappearance of the imaging findings was documented 2 weeks after treatment. Complete endoscopic recovery and absence of clinical alterations were observed during follow-up after 3 months.
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Affiliation(s)
| | | | - Mahmoud Shahin
- Department of Radiology, ERESA Grupo Médico, Valencia, Spain
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Eretta C, Ferrarese A, Olcese S, Imperatore M, Francone E, Bianchi C, Bruno MS, Sagnelli C, Di Martino M, Ranghetti S, Martino V, Falco E, Berti S. Celiac axis compression syndrome: laparoscopic approach in a strange case of chronic abdominal pain in 71 years old man. Open Med (Wars) 2016; 11:248-251. [PMID: 28352803 PMCID: PMC5329836 DOI: 10.1515/med-2016-0049] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2015] [Accepted: 03/07/2016] [Indexed: 01/07/2023] Open
Abstract
Celiac Axis Compression Syndrome by the Median Arcuate Ligament is a very rare condition characterized by chronic postprandial abdominal pain (angina abdominis), nausea, vomiting, which occurs mostly in young patients. The main treatment is a surgical procedure that consists of the division of the arcuate ligament combined with the section of the close diaphragmatic crus and the excision of the celiac plexus. Actually laparoscopic management is feasible and safe.
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Affiliation(s)
| | - Alessia Ferrarese
- Department of Oncology, University of Turin, Section of General Surgery, San Luigi Gonzaga Teaching Hospital, Regione Gonzole 10,10043 Orbassano - Turin, Italy
| | - Sonja Olcese
- Department of Surgery - S. Andrea Hospital, La Spezia, Italy
| | | | - Elisa Francone
- Department of Surgery - S. Andrea Hospital, La Spezia, Italy
| | - Claudio Bianchi
- Department of Surgery - S. Andrea Hospital, La Spezia, Italy
| | | | - Carlo Sagnelli
- Department of Surgery - S. Andrea Hospital, La Spezia, Italy
| | | | | | - Valter Martino
- Department of Surgery, S. Luigi Gonzaga, Orbassano, Torino, Italy
| | - Emilio Falco
- Department of Surgery - S. Andrea Hospital, La Spezia, Italy
| | - Stefano Berti
- Department of Surgery - S. Andrea Hospital, La Spezia, Italy
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Mak GZ, Speaker C, Anderson K, Stiles-Shields C, Lorenz J, Drossos T, Liu DC, Skelly CL. Median arcuate ligament syndrome in the pediatric population. J Pediatr Surg 2013; 48:2261-70. [PMID: 24210197 PMCID: PMC3896126 DOI: 10.1016/j.jpedsurg.2013.03.003] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/05/2013] [Revised: 02/20/2013] [Accepted: 03/02/2013] [Indexed: 02/08/2023]
Abstract
OBJECTIVES Median arcuate ligament syndrome (MALS) is a vascular compression syndrome with symptoms that overlap chronic functional abdominal pain (CFAP). We report our experience treating MALS in a pediatric cohort previously diagnosed with CFAP. PATIENTS AND METHODS We prospectively evaluated 46 pediatric (<21years of age) patients diagnosed with MALS at a tertiary care referral center from 2008 to 2012. All patients had previously been diagnosed with CFAP. Patients were evaluated for celiac artery compression by duplex ultrasound and diagnosis was confirmed by computed tomography. Quality of life (QOL) was determined by pre- and postsurgical administration of PedsQL™ questionnaire. The patients underwent laparoscopic release of the median arcuate ligament overlying the celiac artery which included surgical neurolysis. We examined the hemodynamic changes in parameters of the celiac artery and perioperative QOL outcomes to determine correlation. RESULTS All patients had studies suggestive of MALS on duplex and computed tomography; 91% (n=42) positive for MALS were females. All patients underwent a technically satisfactory laparoscopic surgical release resulting in a significant improvement in blood flow through the celiac artery. There were no deaths and a total of 9 complications, 8 requiring a secondary procedure; 33 patients were administered QOL surveys. 18 patients completed the survey with 15 (83%) patients reporting overall improvement in the QOL. Overall, 31/46 patients (67%) reported improvement of symptoms since the time of surgery. CONCLUSIONS MALS was found to be more common in pediatric females than males. Laparoscopic release of the celiac artery can be performed safely in the pediatric population. Surgical release of the artery and resultant neurolysis resulted in significant improvement in the blood flow, symptoms, and overall QOL in this cohort. The overall improvement in QOL outcome measures after surgery leads us to conclude that MALS might be earlier diagnosed and possibly treated in patients with CFAP. We recommend a multidisciplinary team approach to care for these complex patients.
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Affiliation(s)
- Grace Z Mak
- Section of Pediatric Surgery, Department of Surgery, University of Chicago Medicine, Chicago IL, 60637, USA.
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Abstract
Celiac artery compression syndrome is a rare disorder characterized by episodic abdominal pain and weight loss. It is the result of external compression of celiac artery by the median arcuate ligament. We present a case of celiac artery compression syndrome in a 57-year-old male with severe postprandial abdominal pain and 30-pound weight loss. The patient eventually responded well to surgical division of the median arcuate ligament by laparoscopy.
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El-Hayek KM, Titus J, Bui A, Mastracci T, Kroh M. Laparoscopic median arcuate ligament release: are we improving symptoms? J Am Coll Surg 2012. [PMID: 23177373 DOI: 10.1016/j.jamcollsurg.2012.10.004] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Median arcuate ligament syndrome is a rare disorder characterized by postprandial abdominal pain, weight loss, and celiac stenosis. We report our experience using a laparoscopic approach for this uncommon diagnosis. STUDY DESIGN This is an IRB-approved, prospectively collected retrospective analysis of patients treated with laparoscopic median arcuate ligament release at our institution. Data collected included patient demographics, preoperative symptoms, operative approach, and postoperative outcomes. Ultimately, patients were contacted to complete a postoperative survey aimed at assessing resolution of symptoms and overall satisfaction. RESULTS A total of 15 patients underwent laparoscopic median arcuate ligament release from March 2007 to January 2012. Mean age was 34 years (range 17 to 68 years) and 93% were female. Mean preoperative celiac velocity was 380 cm/s (range 210 to 600 cm/s). Fourteen patients had laparoscopic median arcuate ligament release and 1 patient had robotic-assisted laparoscopic release. Mean operative time was 179 minutes (range 79 to 473 minutes) and there was 1 conversion to laparotomy. Twelve of 15 patients had a postoperative celiac axis ultrasonography. Celiac occlusion occurred in 2 patients (present in 1 patient preoperatively). In the remaining 10 there was a statistically significant decrease in celiac velocity to 215 cm/s (range 135 to 306 cm/s; p = 0.005). Survey response rate was 86% at a mean follow-up of 15.4 months (range 2.8 to 32.6 months), and all but 1 patient reported having resolution of pain. CONCLUSIONS Laparoscopic release of the median arcuate ligament is a safe, feasible, and effective means of managing median arcuate ligament syndrome. Postoperative symptomatic relief is seen in the vast majority of patients undergoing this procedure.
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Affiliation(s)
- Kevin M El-Hayek
- Digestive Disease Institute, Cleveland Clinic, Cleveland, OH 44195, USA
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Okten RS, Kucukay F, Tola M, Bostanci B, Cumhur T. Is celiac artery compression syndrome genetically inherited?: A case series from a family and review of the literature. Eur J Radiol 2012; 81:1089-93. [DOI: 10.1016/j.ejrad.2011.02.064] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2011] [Accepted: 02/28/2011] [Indexed: 10/18/2022]
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Doyle AJ, Chandra A. Chronic Mesenteric Ischemia in a 26-Year-Old Man: Multivessel Median Arcuate Ligament Compression Syndrome. Ann Vasc Surg 2012; 26:108.e5-9. [DOI: 10.1016/j.avsg.2011.10.001] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2011] [Revised: 09/30/2011] [Accepted: 10/08/2011] [Indexed: 12/23/2022]
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Skeik N, Cooper LT, Duncan AA, Jabr FI. Median Arcuate Ligament Syndrome: A Nonvascular, Vascular Diagnosis. Vasc Endovascular Surg 2011; 45:433-7. [DOI: 10.1177/1538574411406453] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Median arcuate ligament syndrome (MALS) is often diagnosed when idiopathic, episodic abdominal pain is associated with dynamic compression of the proximal celiac artery by fibers of the median arcuate ligament. The character of the abdominal pain is often postprandial and associated with gradual weight loss from poor food intake, suggestive of chronic mesenteric ischemia. However, the pathognomonic imaging feature of dynamic, ostial celiac artery compression with expiration does not consistently predict clinical improvement from revascularization. Proposed but unproven pathophysiological mechanisms include neurogenic pain from compression of the splanchnic nerve plexus and intermittent ischemia from compression of the celiac artery. Alterations in blood flow and ganglion compression are both associated with delayed gastric emptying, another physiological correlate of the clinical syndrome. Published reports describe a variable response to revascularization and nerve plexus resection suggest a need for translational research to better characterize this poorly understood clinical entity. We illustrate the current gaps in our knowledge of MALS with the case of a 51-year-old woman with a 4-year history of chronic abdominal pain who responded to a combination of ganglion resection and celiac artery reconstruction.
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Affiliation(s)
- Nedaa Skeik
- Division of Cardiovascular Diseases, Mayo Clinic, Rochester, MN, USA,
| | - Leslie T. Cooper
- Division of Cardiovascular Diseases, Mayo Clinic, Rochester, MN, USA
| | - Audra A. Duncan
- Division of Cardiovascular Diseases, Mayo Clinic, Rochester, MN, USA
| | - Fadi I. Jabr
- Division of Hospital Medicine, Dickson Medical Center, TN, USA
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Pediatric median arcuate ligament syndrome: first report of familial pattern and transperitoneal laparoscopic release. J Pediatr Surg 2010; 45:e17-20. [PMID: 21129525 DOI: 10.1016/j.jpedsurg.2010.08.009] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/03/2010] [Revised: 08/06/2010] [Accepted: 08/06/2010] [Indexed: 11/22/2022]
Abstract
Median arcuate ligament syndrome (MALS) is a rare disorder resulting from luminal narrowing of the celiac artery by the insertion of the diaphragmatic muscle fibers. Surgical management entails division of the median arcuate ligament with or without celiac artery reconstruction. We are presenting an interesting case of a 16-year-old girl with postprandial abdominal pain and weight loss. Her mother also had MALS treated via open celiotomy with complete median arcuate ligament division and patch angioplasty of the celiac artery owing to persistent stenosis at our institution. After a diagnosis of MALS was confirmed in our patient, a transperitoneal laparoscopic release of the median arcuate ligament with skeletonization of the celiac artery and branch vessels was performed. The postoperative course was uneventful, and she was dismissed on postoperative day 2. She remains asymptomatic at 12-months follow-up. This represents the first report of a transperitoneal laparoscopic approach to MALS in an adolescent and the first report of a familial/generational component to MALS.
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Duffy AJ, Panait L, Eisenberg D, Bell RL, Roberts KE, Sumpio B. Management of Median Arcuate Ligament Syndrome: A New Paradigm. Ann Vasc Surg 2009; 23:778-84. [PMID: 19128929 DOI: 10.1016/j.avsg.2008.11.005] [Citation(s) in RCA: 94] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2008] [Revised: 10/31/2008] [Accepted: 11/06/2008] [Indexed: 10/21/2022]
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Trellopoulos G, Pikilidou MI, Tsiga E. Celiac artery embolism due to thrombophilia - a case report. Int J Angiol 2009; 18:96-8. [PMID: 22477502 PMCID: PMC2780852 DOI: 10.1055/s-0031-1278334] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2022] Open
Abstract
A case of celiac artery embolism in a patient with factor V Leiden thrombophilia is reported. The embolism was likely due to an undetected cardiac thrombus, causing an abdominal aortic embolism. The patient underwent emergency surgery for the abdominal embolism. The celiac artery embolism was treated nonsurgically due to the presence of collateral circulation through the gastroduodenal artery from the superior mesenteric artery. The patient fully recovered and was discharged from the hospital one month after his first referral.
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Affiliation(s)
| | - Maria I Pikilidou
- Second Department of Internal Medicine, Papanikolaou General Hospital, Thessaloniki, Greece
| | - Evaggelia Tsiga
- Second Department of Internal Medicine, Papanikolaou General Hospital, Thessaloniki, Greece
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22
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Celiac Revascularization as a Requisite for Treating the Median Arcuate Ligament Syndrome. Ann Vasc Surg 2008; 22:571-4. [DOI: 10.1016/j.avsg.2008.02.007] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2007] [Revised: 01/17/2008] [Accepted: 02/13/2008] [Indexed: 11/19/2022]
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Jarry J, Berard X, Ducasse E, Biscay D, Pailler A, Sassoust G, Midy D, Baste JC. [Laparoscopic management of median arcuate ligament syndrome]. ACTA ACUST UNITED AC 2008; 33:30-4. [PMID: 18313874 DOI: 10.1016/j.jmv.2007.11.002] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2007] [Accepted: 11/19/2007] [Indexed: 11/18/2022]
Abstract
Median arcuate ligament syndrome is a rare disorder resulting from luminal narrowing of the celiac trunk. The classic management of median arcuate ligament syndrome involves the surgical division of the median arcuate ligament fibers in order to decompress the celiac trunk. This has traditionally required an upper midline incision. A few authors have described a successful laparoscopic release of celiac artery compression syndrome. Laparoscopy provides a less invasive, but equally effective method for decompressing the celiac trunk.
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Affiliation(s)
- J Jarry
- Service de chirurgie viscérale, hôpital Robert-Picqué, 351, route de Toulouse, 33140 Villenave-d'Ornon, France.
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24
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Mucs M, Székely I, Illés I, Juhász A, Paál B, Sárkány A, Madácsy L, Altorjay A. Celiac artery compression syndrome – stepchild of abdominal angina? Orv Hetil 2007; 148:1763-6. [PMID: 17827086 DOI: 10.1556/oh.2007.28126] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
A krónikus, étkezéssel összefüggést nem mutató epigastrialis fájdalmak hátterében az esetek néhány százalékában a truncus coeliacus külső kompressziója áll.
Esetismertetés:
A szerzők egy 58 éves nőbeteg kórtörténetét ismertetik, akinél a hasi szervek ischaemiája, a felhasi fájdalom hátterében a preoperatív kivizsgálás a truncus coeliacuson rövid szakaszú stenosist okozó, a rekeszizom-hiátus aorticusát övező inas-izmos ívet igazolt. Előkészítést követően műtétet végeztünk, a trifurcatio eredésétől számított 8–10 mm-re levő heges, gyűrűszerű leszorítást felhasítottuk, a ganglion coeliacum egy részét eltávolítottuk. A beteg a posztoperatív 6. napon gyógyultan, panaszmentesen otthonába távozott.
Megbeszélés:
A klasszikus értelemben vett angina abdominalis a hasi szervek relatív ischaemiájának következménye. Ennek oka legtöbbször az érintett ér betegsége. Az artéria külső kompressziója csupán az esetek pár százalékát jelenti. A truncus coeliacus esetében ezt betegünknél a rekeszizom-hiátus aorticusát övező inas megerősödés okozta. A kivizsgálás során az erre utaló első jel az ér felett hallható „surranás” volt, a poststenoticus turbulens áramlás miatt. Az erre alapozott részletes radiológiai vizsgálatok igazolták a tényleges kórokot. Ennek ismeretében a felszabadító műtét teljes tünet- és panaszmentességet eredményezett.
Következtetés:
Bizonytalan hasi panaszok esetén gondolnunk kell az arteria coeliaca stenosisának lehetőségére is. Esetismertetésünkkel kívánjuk felhívni a figyelmet a hasi auscultatio jelentőségére, amely elengedhetetlen része a gasztroenterológiai vizsgálatoknak. A diagnózis felállításában a Doppler-duplexvizsgálat mellett komoly segítséget jelentettek az érfestési eljárások. A műtét lényegét képező érfelszabadítást célszerű mielőbb elvégezni, még mielőtt a tartós külső kompresszió degeneratív érfalelváltozást okoz.
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Affiliation(s)
- Mihály Mucs
- Fejér Megyei Szent György Kórház, Altalános Sebészeti Osztály, Székesfehérvár
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25
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Abstract
BACKGROUND/METHODS Celiac trunk compression syndrome is a rare cause of recurrent, nonspecific upper abdominal pain. In this article, we present 3 cases of celiac trunk compression syndrome in 15- and 16-year-old adolescents who were treated surgically in our clinic and discuss our findings with existing literature. RESULTS All 3 adolescents complained about unspecific upper gastrointestinal pain. The performance of digital subtraction angiography and, accordingly, magnetic resonance angiography showed, respectively, a stenosis and an occlusion of the celiac artery. In all cases, a decompression of the celiac trunk as well as a resection of the celiac plexus in the region near the outlet of the trunk was performed. Patients have been surveyed between 12 and 18 months postoperatively. In all cases, the gastrointestinal symptoms have completely disappeared. DISCUSSION Celiac artery compression syndrome is understood to consist of symptoms of recurrent pain, caused by a neurovascular narrowing of the aortic hiatus and celiac trunk. The surgical approach of choice is sharp transection of the median arcuate ligament, along with complete resection of the nerve fibers of the celiac plexus with or without performance of revascularisation. In summary, celiac trunk compression syndrome is a rare cause of recurrent epigastric pain that should be not be ignored completely as a differential diagnosis.
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Affiliation(s)
- Thomas Foertsch
- Department of Vascular Surgery, University of Erlangen-Nuremberg, 91054 Erlangen, Germany.
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26
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Sianesi M, Soliani P, Arcuri MF, Bezer L, Iapichino G, Del Rio P. Dunbar's syndrome and superior mesenteric artery's syndrome: a rare association. Dig Dis Sci 2007; 52:302-5. [PMID: 17160476 DOI: 10.1007/s10620-006-9438-0] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/15/2006] [Accepted: 05/12/2006] [Indexed: 12/09/2022]
Abstract
Celiac artery compression syndrome (CACS) and superior mesenteric artery syndrome (SMAS) are 2 rare diseases, widely described in literature. Their association has not been specifically investigated; in fact, few cases have been reported. For this reason we reviewed our experience from January 1974 to June 2004. We report 59 patients affected by CACS and 28 by SMAS. Coexistence of both syndromes in 8 patients was observed. These 8 patients were successfully treated with duodenojejunal bypass and decompression of the celiac trunk. In this paper, we analyze the pathogenesis, clinical presentation, diagnosis, and treatment of these syndromes, emphasizing their common aspects. The misdiagnosis of this association may justify in some cases the controversial results reported regarding the surgical treatment of these syndrome.
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Affiliation(s)
- Mario Sianesi
- Istituto di Clinica Chirurgica Generale e dei Trapianti d'Organo Università di Parma, Via Gramsci 14, 43100, Parma, Italy
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27
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Karamlou T, Landry GJ, Taylor LM, Moneta GL. Epidemiology and Pathophysiology. Vasc Med 2006. [DOI: 10.1016/b978-0-7216-0284-4.50031-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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28
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Schweizer P, Berger S, Schweizer M, Schaefer J, Beck O. Arcuate ligament vascular compression syndrome in infants and children. J Pediatr Surg 2005; 40:1616-22. [PMID: 16226994 DOI: 10.1016/j.jpedsurg.2005.06.040] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
BACKGROUND Arcuate ligament vascular compression syndrome has not been described previously in the pediatric or pediatric surgical literature. However, it is mentioned in the literature of vascular and general surgery and in journals of radiology and orthopedics. In this review, the intraoperative pathological anatomy and the principles of treatment for 8 children will be presented. METHODS The chart records and the anatomical sketches that were documented by the surgeon immediately after each procedure were analyzed retrospectively. In addition, preoperative courses and long-term follow-up (range, 3-18 years) were evaluated by a defined program. RESULTS The diagnosis of celiac artery compression by an arcuate ligament was suspected in children presenting with a history of several years of recurrent acute abdominal pain associated with a typical arterial bruit in the midline of the epigastric region. CONCLUSIONS Other diseases with recurrent abdominal pain and an arterial bruit must be excluded before making the decision for an operative intervention. Duplex ultrasound and angiography are possibly helpful tools to establish the respective diagnosis, but in the patients of the present series, these techniques neither confirmed compression of the celiac axis nor demonstrated decreased perfusion of the superior mesenteric artery. However, as the clinical symptoms clearly announce the disease, these diagnostic measures are not mandatory.
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Affiliation(s)
- Paul Schweizer
- Department of Pediatric Surgery, University of Tübingen, 72076 Tübingen, Germany.
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29
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Kadry Z, Furrer K, Selzner M, Pfammatter T, Clavien PA. Right living donor hepatectomy in the presence of celiac artery stenosis. Transplantation 2003; 75:769-72. [PMID: 12660499 DOI: 10.1097/01.tp.0000055255.41393.b5] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Incidental celiac artery stenosis has been cited as an exclusion criterion for adult donor right hepatectomy. METHODS We report our experience involving right donor hepatectomy performed in the presence of isolated high-grade (greater than 80%) celiac trunk stenosis in two young healthy and asymptomatic adult living liver donors. RESULTS The immediate postoperative course was complicated by a superficial wound infection in one patient and a transient median nerve palsy caused by intraoperative positioning, which spontaneously resolved, in the second patient. Both were discharged within 7 to 10 days postoperatively. They are doing well at 1 year follow-up without any complaints and have both returned to 100% full employment. CONCLUSIONS Our results show that right donor hepatectomy can be safely performed in the presence of significant celiac artery stenosis. However, careful long-term follow-up will be required to monitor for any future progression of mesenteric vascular disease.
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Affiliation(s)
- Zakiyah Kadry
- Department of Visceral and Transplantation Surgery, University Hospital of Zurich, Zurich, Switzerland
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30
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Kalra M, Panneton JM, Hofer JM, Andrews JC. Aneurysm and stenosis of the celiomesenteric trunk: a rare anomaly. J Vasc Surg 2003; 37:679-82. [PMID: 12618711 DOI: 10.1067/mva.2003.37] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
A celiomesenteric trunk (CMT) anomaly is extremely rare, occurring in less than 0.5% of people. We describe two cases of CMT anomaly treated surgically for median arcuate ligament compression with stenosis causing intestinal angina and an asymptomatic aneurysm. Disease involving a CMT is extremely uncommon. This comprises the first report of symptomatic median arcuate ligament compression of a CMT. Only four cases of aneurysmal disease are reported so far. Indications and technique of surgical repair of CMT aneurysms are similar to those used for splanchnic artery aneurysms.
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Affiliation(s)
- Manju Kalra
- Division of Vascular Surgery, Mayo Clinic, 200 First Street SW, Rochester, MN 55905, USA
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31
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Linares P, Vivas S, Dominguez A, Jorquera F, Muñoz F, Espinel J, Herrera A, Olcoz JL. An uncommon association of abdominal vascular compression syndromes: Dumbar and Nutcracker. Eur J Gastroenterol Hepatol 2002; 14:1151-3. [PMID: 12362107 DOI: 10.1097/00042737-200210000-00017] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/10/2022]
Abstract
Abdominal pain associated with nausea and vomiting in a young patient led to a diagnosis of median arcuate ligament syndrome. The presence of mild haematuria was associated with a concomitant Nutcracker syndrome. Diagnosis was achieved by a computed tomography scan, which showed compression of the vessels of the coeliac axis and left renal vein. These syndromes are very rare, and their association in the same patient has not been described before. There is no relationship in the aetiology of these entities. In this report we discuss the diagnosis and therapeutic options, and review the literature.
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Affiliation(s)
- Pedro Linares
- Gastroenterology Service, Hospital de León, Altos de Nava s/n, 24008 León, Spain.
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32
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Abstract
The embryogenesis, congenital anomalies, and surgical anatomy and applications of the esophagus for benign and malignant processes are detailed in this article. Emphasis is placed on the role of embryology and the anatomy involved in surgical decisions.
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Affiliation(s)
- J E Skandalakis
- Center for Surgical Anatomy, Emory University School of Medicine, Atlanta, Georgia, USA
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33
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Abstract
The celiac artery compression syndrome (CACS) is an infrequently described clinical condition with poorly defined diagnostic criteria and an obscure pathophysiology. It is usually associated with an extrinsic compression upon the celiac axis near its takeoff from the aorta by fibrous diaphragmatic bands or sympathetic neural fibers. We present a patient with CACS who suffered a recurrence of her original abdominal complaints.http://link.springer-ny.com/link/service/journals/00547/bibs/8n3p150.html
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34
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Cappell MS. Intestinal (mesenteric) vasculopathy. II. Ischemic colitis and chronic mesenteric ischemia. Gastroenterol Clin North Am 1998; 27:827-60, vi. [PMID: 9890115 DOI: 10.1016/s0889-8553(05)70034-0] [Citation(s) in RCA: 79] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
Ischemic colitis accounts for approximately half of all cases of mesenteric vasculopathy. The clinical presentation varies depending on underlying cause, extent of vascular obstruction, rapidity of ischemic insult, degree of collateral circulation, and presence of comorbidity. Ischemic colitis is usually diagnosed by colonoscopy. Only approximately 20% of patients require surgery because of signs or laboratory findings of peritonitis or because of clinical deterioration. Approximately 20% of patients develop chronic colitis from irreversible colonic ischemic injury, which manifests clinically as persistent diarrhea, rectal bleeding, or weight loss and endoscopically as a colonic stricture or mass. Chronic mesenteric ischemia is almost always caused by significant atherosclerotic stenosis involving at least two mesenteric arteries, usually the superior mesenteric artery and celiac axis. The classic symptomatic triad of postprandial pain, fear of eating, and involuntary weight loss occurs with advanced disease.
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Affiliation(s)
- M S Cappell
- Department of Medicine, Maimonides Medical Center, Brooklyn, New York, USA
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35
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Abstract
Compression of the visceral arteries can produce true mesenteric ischemia, but the syndrome is rare. The syndrome is caused by unfavorable anatomic relationships at the aortic hiatus among the CA, the SMA, and overlying structures, particularly the diaphragmatic crura. These anatomic relationships, in contrast to the syndrome they sometimes produce, are relatively common, which makes the detection of CA compression only a prerequisite to the diagnosis of the clinical entity. The diagnosis of CA compression syndrome ultimately depends on the relentless elimination of other possible causes for abdominal pain and on the knowledge that this curious syndrome does indeed exist. If properly diagnosed, the CA compression syndrome can be corrected with a safe, relatively simple surgical procedure. Past treatment series reflect too little appreciation for the extensiveness of a true, chronic CA injury. Revascularization of the CA, in addition to release of compression, should therefore be performed with greater frequency in the future. The young patients who are successfully diagnosed and treated for this unusual syndrome are frequently entirely relieved of long-standing, debilitating pain, and, like other patients with chronic mesenteric ischemia, they typically enjoy dramatic improvement in the quality of their lives. Thus, with the prospect of these patients in mind, a clinician should accept the opinion that the syndrome "does not exist" only after careful consideration of the entire literature.
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Affiliation(s)
- F R Bech
- Section of Vascular Surgery, Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire, USA
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36
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Abstract
Owing to a heightened awareness of the disease as well as improved diagnostic tests, chronic mesenteric ischemia is now recognized as a more common cause of abdominal pain. The classic symptoms of postprandial abdominal pain with weight loss are evident in the majority of proven cases; most patients also have other evidence of advanced atherosclerotic vascular disease. Several new diagnostic techniques are being developed and tested, most notably color duplex imaging, although angiography still remains the diagnostic gold standard. It is hoped that better noninvasive testing may eventually eliminate the need for angiography, as well as lead to a more expedient diagnosis of chronic mesenteric ischemia.
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Affiliation(s)
- J Moawad
- Department of Surgery, University of Chicago, Illinois, USA
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37
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Abstract
Although complications of generalized atherosclerosis most commonly cause intestinal ischemia, a number of unusual causes may be responsible. These unusual causes can be grouped into six major categories: (1) mechanical, (2) drugs, (3) hematologic, (4) endocrine, (5) vasculopathies, and (6) miscellaneous. Morbidity and mortality rates remain high because these rare diseases frequently go unrecognized until patients suffer adverse outcomes. A high index of suspicion may decrease the delay in diagnosis of mesenteric ischemia caused by these disorders.
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Affiliation(s)
- W C Krupski
- Department of Surgery, University of Colorado Health Sciences Center, Denver, USA
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38
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Bradbury AW, Brittenden J, McBride K, Ruckley CV. Mesenteric ischaemia: a multidisciplinary approach. Br J Surg 1995; 82:1446-59. [PMID: 8535792 DOI: 10.1002/bjs.1800821105] [Citation(s) in RCA: 177] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
Mesenteric ischaemia may result from a wide range of pathological processes, each possessing unique clinical features, diagnostic difficulties, management strategies and outcome. Regardless of aetiology, prognosis depends crucially on rapid diagnosis and institution of treatment to prevent, or at least to minimize, bowel infarction. Progress in understanding the pathophysiology of mesenteric ischaemia has led to novel methods of treatment, so that in some circumstances therapy may be purely medical. More often surgery is required and is frequently life saving. Percutaneous transcatheter techniques are increasingly employed in both diagnosis and treatment. Close cooperation between radiologists, physicians and surgeons is therefore necessary if clinical outcome is to be optimized. This paper reviews the modern interdisciplinary management of mesenteric ischaemia in the light of recent advances.
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Affiliation(s)
- A W Bradbury
- University Department of Surgery, Royal Infirmary, Edinburgh, UK
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