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Problems with the Median Arcuate Ligament Should Be Recognized before Surgery; Its Importance in
Özdil Başkan1, Yaşar Özdenkaya2, Cengiz Erol1
1Department of Radiology, İstanbul Medipol University, İstanbul, Turkey.
Insights
Median arcuate ligament (MAL) compression causes celiac artery stenosis (CAS), a condition that can lead to upper abdominal organ ischemia. Early diagnosis via imaging is crucial before procedures.
Area of Science:
- Vascular Surgery
- Radiology
- Gastroenterology
Background:
- Celiac artery stenosis (CAS) is a common finding, often caused by median arcuate ligament (MAL) compression.
- MAL, a fibrous arch, can abnormally position, constricting the celiac artery origin.
Purpose of the Study:
- To highlight the importance of recognizing celiac artery stenosis and its etiology before surgical interventions.
- To emphasize the role of advanced imaging in diagnosing MAL-induced CAS.
Main Methods:
- A case report detailing a patient diagnosed with CAS during pancreaticoduodenectomy.
- Preoperative computed tomography (CT) identified MAL as the cause of CAS.
Main Results:
- The patient presented with a gastric bulbus mass and was found to have CAS.
- CT confirmed MAL as the etiology of the celiac artery stenosis.
Conclusions:
- CAS, though often asymptomatic due to collateral circulation, can cause severe ischemia if collaterals are disrupted.
- Radiologists must be aware of CAS and its MDCT findings, especially before invasive procedures.
Background:
Celiac artery stenosis (CAS) is a not a rare finding in the general population. The median arcuate ligament (MAL) is a fibrous arch that unites the diaphragmatic crura on either side of the aortic hiatus and, while it normally passes cranial to the origin of the celiac truncus, a low-lying ligament may lead to compression of the celiac artery and is the one of the major causes of CAS.
Case Report:
In this paper, we present a patient with a mass in the gastric bulbus who was diagnosed with celiac artery stenosis during the pancreaticoduodenectomy (PD). MAL was the cause of the celiac artery stenosis, determined based on the findings of preoperative computed tomography (CT).
Conclusion:
Although CAS is usually asymptomatic due to the collateral blood supply, it may be associated with potentially disastrous results due to ischemia of the upper abdominal organs as a result of disruption of the collateral pathways. It is especially important to recognize the presence of CAS and its etiology before interventional procedures. With the increasing use of multidetector computed tomography (MDCT), it becomes essential for radiologists to be aware of this entity and the cross-sectional findings.
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