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Hofmann K, Lareida A, Bächler T, Breitenstein S, Kambakamba P. Recurrent aneurysmatic bleeding of pancreaticoduodenal aneurysm due to median arcuate ligament syndrome: a case report. J Surg Case Rep 2024; 2024:rjae364. [PMID: 38817786 PMCID: PMC11138111 DOI: 10.1093/jscr/rjae364] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2024] [Accepted: 05/16/2024] [Indexed: 06/01/2024] Open
Abstract
Median arcuate ligament syndrome (MALS) involves coeliac artery compression, causing a range of symptoms from chronic pain to life-threatening complications. This case features a 52-year-old patient with recurrent retroperitoneal bleeding from MALS-related inferior pancreaticoduodenal artery aneurysms (PDAAs). Emergency interventions, including surgical bleeding control, angioplasty, percutaneous drainage, and median arcuate ligament release, were conducted. The case highlights challenges in diagnosing and managing MALS-related PDAA, emphasizing the importance of early identification and tailored interventions based on clinical symptoms and imaging. Surgical intervention to release the ligament is the primary treatment, with considerations for prophylactic intervention in PDAA cases. Lack of established PDAA management protocols underscores the need for prompt intervention to prevent complications. In conclusion, this report stresses the association between MALS and PDAA, advocating for early identification and tailored management to mitigate complications.
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Affiliation(s)
- Kyra Hofmann
- Department of General Surgery, Kantonsspital Schaffhausen, 8208 Schaffhausen, Switzerland
| | - Anna Lareida
- Department of Surgery, Clinic for Visceral and Thoracic Surgery, Kantonsspital Winterthur, 8400 Winterthur, Switzerland
| | - Thomas Bächler
- Department of Surgery, Clinic for Visceral and Thoracic Surgery, Kantonsspital Winterthur, 8400 Winterthur, Switzerland
| | - Stefan Breitenstein
- Department of Surgery, Clinic for Visceral and Thoracic Surgery, Kantonsspital Winterthur, 8400 Winterthur, Switzerland
| | - Patryk Kambakamba
- Department of Surgery, Clinic for Visceral and Thoracic Surgery, Kantonsspital Winterthur, 8400 Winterthur, Switzerland
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Giakoustidis A, Moschonas S, Christodoulidis G, Chourmouzi D, Diamantidou A, Masoura S, Louri E, Papadopoulos VN, Giakoustidis D. Median arcuate ligament syndrome often poses a diagnostic challenge: A literature review with a scope of our own experience. World J Gastrointest Surg 2023; 15:1048-1055. [PMID: 37405099 PMCID: PMC10315115 DOI: 10.4240/wjgs.v15.i6.1048] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/27/2022] [Revised: 02/05/2023] [Accepted: 04/18/2023] [Indexed: 06/15/2023] Open
Abstract
The median arcuate ligament syndrome (MALS) is recognized as a rare clinical entity, characterized by chronic post-prandial abdominal pain, nausea, vomiting, and unintentional weight loss. Due to its vague symptomatology, it is mainly regarded as a diagnosis of exclusion. Patients can often be misdiagnosed for several years before a correct diagnosis is established, also due to a medical team’s clinical suspicion. We present a case series of two patients who suffered from MALS and were treated successfully. The first patient is a 32-year-old woman, presenting with post-prandial abdominal pain and weight loss that have lasted for the past ten years. The second patient, a 50-year-old woman, presented with similar symptomatology, with the symptoms lasting for the last five years. Both cases were treated by laparoscopic division of the median arcuate ligament fibers, which alleviated extrinsic pressure from the celiac artery. Previous cases of MALS were retrieved from PubMed, to assemble a better diagnostic algorithm and propose a treatment method of choice. The literature review suggests an angiography with a respiratory variation protocol as the diagnostic modality of choice, along with the laparoscopic division of the median arcuate ligament fibers as the proposed treatment of choice.
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Affiliation(s)
- Alexandros Giakoustidis
- Department of Surgery, General Hospital Papageorgiou, Aristotle University of Thessaloniki, Thessaloniki 56429, Greece
- Fifth Department of Surgery, Interbalkan European Medical Centre, Thessaloniki 55535, Greece
| | - Stavros Moschonas
- Department of Surgery, General Hospital Papageorgiou, Aristotle University of Thessaloniki, Thessaloniki 56429, Greece
| | | | - Danae Chourmouzi
- Fifth Department of Surgery, Interbalkan European Medical Centre, Thessaloniki 55535, Greece
| | - Anna Diamantidou
- Fifth Department of Surgery, Interbalkan European Medical Centre, Thessaloniki 55535, Greece
| | - Sophia Masoura
- Fifth Department of Surgery, Interbalkan European Medical Centre, Thessaloniki 55535, Greece
| | - Eleni Louri
- Fifth Department of Surgery, Interbalkan European Medical Centre, Thessaloniki 55535, Greece
| | - Vasileios N Papadopoulos
- Department of Surgery, General Hospital Papageorgiou, Aristotle University of Thessaloniki, Thessaloniki 56429, Greece
| | - Dimitrios Giakoustidis
- Department of Surgery, General Hospital Papageorgiou, Aristotle University of Thessaloniki, Thessaloniki 56429, Greece
- Fifth Department of Surgery, Interbalkan European Medical Centre, Thessaloniki 55535, Greece
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