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Updated: Mar 13, 2026
Management of the Uncinate Process in No-Touch Laparoscopic Pancreaticoduodenectomy
Published on: May 5, 2023
Acute median arcuate ligament syndrome after pancreaticoduodenectomy
Ilhan Karabicak1, Sohei Satoi2, Hiroaki Yanagimoto1
1Department of Surgery, Kansai Medical University, 2-5-1, Shin-machi, Hirakata, Osaka, 573-1010, Japan.
Abstract:
Median arcuate ligament syndrome (MALS) has been reported in 2-7.6 % of patients undergoing pancreaticoduodenectomy (PD). Most of the reported cases of MALS have been diagnosed perioperatively and treated radiologically or surgically before or during PD. MALS can have an acute postoperative onset after PD even if all preoperative and intraoperative evaluations are normal particularly in young patients.In this report, we present a second case of severe hepatic cytolysis secondary to MALS that developed acutely and the first patient who required acute division of the median arcuate ligament after PD.
Insights
Median arcuate ligament syndrome (MALS) can acutely develop after pancreaticoduodenectomy (PD), even with normal preoperative evaluations. This report details a case requiring urgent MALS treatment post-PD.
Area of Science:
- Gastroenterology
- Vascular Surgery
- Hepatology
Background:
- Median arcuate ligament syndrome (MALS) is a rare condition affecting the celiac artery.
- MALS incidence in pancreaticoduodenectomy (PD) patients ranges from 2-7.6%.
- MALS is typically diagnosed preoperatively or intraoperatively.
Purpose of the Study:
- To report a case of acute hepatic cytolysis secondary to MALS after PD.
- To highlight the first instance of requiring acute median arcuate ligament division post-PD.
Main Methods:
- Case report presentation.
- Review of perioperative and postoperative findings.
- Description of surgical intervention for MALS.
Main Results:
- A young patient developed severe hepatic cytolysis post-PD.
- MALS was diagnosed postoperatively, necessitating acute surgical intervention.
- Median arcuate ligament division successfully treated the MALS complication.
Conclusions:
- MALS can present acutely after PD, irrespective of preoperative assessments.
- Prompt diagnosis and surgical management of MALS are crucial for preventing severe complications like hepatic cytolysis.
- This case underscores the importance of considering MALS in postoperative complications following PD.
