Abstract

Case Report

Laparoscopic surgical treatment of median arcuate ligament syndrome with the retrograde division technique: a case report

Fahri Yetisir*, Afruz Babayeva and Kerim Güzel

Published: 18 May, 2022 | Volume 6 - Issue 1 | Pages: 021-024

Median arcuate ligament syndrome is a rare entity. This clinical condition develops by compression of the root of a celiac artery with the median arcuate ligament. The typical triad of this syndrome is the following; abdominal discomfort and pain, especially after a meal, and weight loss. In diagnosis, other causes should be ruled out and compression must be demonstrated by any type of imaging method. The main principle of treatment is cutting down the median arcuate ligament. A 54-year-old woman presented with untreatable recurrent abdominal pain and was diagnosed with median arcuate ligament syndrome by imaging with angiographic computed tomography. This patient was operated on. We performed laparoscopic division of median arcuate ligament with the retrograde surgical dissection technique. The patient was discharged from the hospital without any complaint on the third day after surgery. She was still symptom-free after 12 months.
The laparoscopic retrograde dissection approach is a safe and feasible treatment modality for median arcuate ligament syndrome.

Read Full Article HTML DOI: 10.29328/journal.acgh.1001034 Cite this Article Read Full Article PDF

Keywords:

Median arcuate ligament syndrome; Celiac artery syndrome; Laparoscopic division of arcuate

References

  1. Cienfuegos JA, Rotellar F, Valentí V, Arredondo J, Pedano N, Bueno A, Vivas I. The celiac axis compression syndrome (CACS): critical review in the laparoscopic era. Rev Esp Enferm Dig. 2010 Mar;102(3):193-201. English, Spanish. doi: 10.4321/s1130-01082010000300006. PMID: 20373834.
  2. Horton KM, Talamini MA, Fishman EK. Median arcuate ligament syndrome: evaluation with CT angiography. Radiographics. 2005 Sep-Oct;25(5):1177-82. doi: 10.1148/rg.255055001. PMID: 16160104.
  3. Cienfuegos JA, Estevez MG, Ruiz-Canela M, Pardo F, Diez-Caballero A, Vivas I, Bilbao JI, Martí-Cruchaga P, Zozaya G, Valentí V, Hernández-Lizoáin JL, Rotellar F. Laparoscopic Treatment of Median Arcuate Ligament Syndrome: Analysis of Long-Term Outcomes and Predictive Factors. J Gastrointest Surg. 2018 Apr;22(4):713-721. doi: 10.1007/s11605-017-3635-3. Epub 2017 Nov 28. PMID: 29185149.
  4. Trinidad-Hernandez M, Keith P, Habib I, White JV. Reversible gastroparesis: functional documentation of celiac axis compression syndrome and postoperative improvement. Am Surg. 2006 Apr;72(4):339-44. PMID: 16676860.
  5. Jimenez JC, Rafidi F, Morris L. True celiac artery aneurysm secondary to median arcuate ligament syndrome. Vasc Endovascular Surg. 2011 Apr;45(3):288-9. doi: 10.1177/1538574411399155. PMID: 21478249.
  6. 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 Nov-Dec;23(6):778-84. doi: 10.1016/j.avsg.2008.11.005. Epub 2009 Jan 6. PMID: 19128929.
  7. Sun Z, Zhang D, Xu G, Zhang N. Laparoscopic treatment of median arcuate ligament syndrome. Intractable Rare Dis Res. 2019 May;8(2):108-112. doi: 10.5582/irdr.2019.01031. PMID: 31218160; PMCID: PMC6557235.
  8. Baccari P, Civilini E, Dordoni L, Melissano G, Nicoletti R, Chiesa R. Celiac artery compression syndrome managed by laparoscopy. J Vasc Surg. 2009 Jul;50(1):134-9. doi: 10.1016/j.jvs.2008.11.124. PMID: 19563961.
  9. Hongsakul K, Rookkapan S, Sungsiri J, Tubtawee T. A severe case of median arcuate ligament syndrome with successful angioplasty and stenting. Case Rep Vasc Med. 2012;2012:129870. doi: 10.1155/2012/129870. Epub 2012 Sep 19. PMID: 23050191; PMCID: PMC3459250.
  10. Roayaie S, Jossart G, Gitlitz D, Lamparello P, Hollier L, Gagner M. Laparoscopic release of celiac artery compression syndrome facilitated by laparoscopic ultrasound scanning to confirm restoration of flow. J Vasc Surg. 2000 Oct;32(4):814-7. doi: 10.1067/mva.2000.107574. PMID: 11013046.
  11. Reilly LM, Ammar AD, Stoney RJ, Ehrenfeld WK. Late results following operative repair for celiac artery compression syndrome. J Vasc Surg. 1985 Jan;2(1):79-91. PMID: 3965762.
  12. Carbonell AM, Kercher KW, Heniford BT, Matthews BD. Multimedia article. Laparoscopic management of median arcuate ligament syndrome. Surg Endosc. 2005 May;19(5):729. doi: 10.1007/s00464-004-6010-x. PMID: 15965588.
  13. Wani S, Wakde V, Patel R, Patankar R, Mathur SK. Laparoscopic release of median arcuate ligament. J Minim Access Surg. 2012 Jan;8(1):16-8. doi: 10.4103/0972-9941.91775. PMID: 22303084; PMCID: PMC3267330.

Figures:

Figure 1

Figure 1

Figure 1

Figure 2

Figure 1

Figure 3

Figure 1

Figure 4

Similar Articles

Recently Viewed

Read More

Most Viewed

Read More