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Case Reports
. 2018 Jul-Sep;17(3):252-256.
doi: 10.1590/1677-5449.000118.

Laparoscopic treatment of celiac axis compression by the median arcuate ligament and endovascular repair of a pancreaticoduodenal artery aneurysm: case report

Marcio Miyamotto  1   2   3 , Cecilia Naomi Kanegusuku  4 , Carla Mariko Okabe  4 , Christiano Marlo Paggi Claus  5 , Fernanda Zandavalli Ramos  3 , Ágata Rothert  4 , Ana Paula Nudelmann Gubert  6 , Ricardo César Rocha Moreira  3
Affiliations
Case Reports

Laparoscopic treatment of celiac axis compression by the median arcuate ligament and endovascular repair of a pancreaticoduodenal artery aneurysm: case report

Marcio Miyamotto et al. J Vasc Bras. 2018 Jul-Sep.

Abstract
in English, Portuguese

Compression of the celiac axis by the median arcuate ligament of the diaphragm can cause nonspecific symptoms such as abdominal pain, vomiting, and weight loss. There is a known association between stenosis or occlusion of the celiac trunk and aneurysms of the pancreaticoduodenal artery. Treatment strategies for patients who have this association should be selected on a case-by-case basis. We describe the case of a patient with pancreaticoduodenal artery aneurysm associated with compression of the celiac trunk by the arcuate ligament, which were managed with endovascular and laparoscopic techniques, respectively.

Resumo: A compressão do tronco celíaco pelo ligamento arqueado mediano do diafragma pode causar sintomas inespecíficos como dor abdominal, vômitos e emagrecimento. Existe uma associação comprovada entre estenoses ou oclusões do tronco celíaco e aneurismas da artéria pancreatoduodenal. Nas situações em que essa associação ocorre, a estratégia de tratamento deve ser individualizada. Relatamos o caso de uma paciente com aneurisma de artéria pancreatoduodenal associado à compressão do tronco celíaco pelo ligamento arqueado, manejados, respectivamente, por técnicas endovasculares e laparoscópicas.

Keywords: celiac plexus compression; median arcuate ligament syndrome; pancreaticoduodenal artery aneurysm.

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Conflict of interest statement

Conflicts of interest: No conflicts of interest declared concerning the publication of this article.

Figures

Figure 1
Figure 1. Angiotomography showing a pancreaticoduodenal artery aneurysm and compression of the origin of the celiac trunk by the arcuate ligament of the diaphragm, causing stenosis exceeding 90%.
Figure 2
Figure 2. Relieving compression of the celiac trunk by sectioning the arcuate ligament via videolaparoscopy.
Figure 3
Figure 3. Doppler ultrasonography conducted after sectioning the arcuate ligament, showing absence of compression of the celiac trunk, leaving only residual stenosis with post-stenotic dilation. CT = celiac trunk; SMA = superior mesenteric artery.
Figure 4
Figure 4. Embolization of the pancreaticoduodenal artery aneurysm with controlled release coils.
Figura 1
Figura 1. Angiotomografia evidenciando a presença de aneurisma de artéria pancreatoduodenal e compressão da origem do tronco celíaco pelo ligamento arqueado do diafragma, gerando estenose acima de 90%.
Figura 2
Figura 2. Liberação da compressão do tronco celíaco através da secção do ligamento arqueado por videolaparoscopia.
Figura 3
Figura 3. Eco-Doppler realizado após a secção do ligamento arqueado mostrando a ausência de compressão do tronco celíaco, restando apenas uma estenose residual com dilatação pós-estenótica. TC = tronco celíaco; MS = mesentérica superior.
Figura 4
Figura 4. Embolização do aneurisma de artéria pancreatoduodenal com molas de liberação controlada.
See this image and copyright information in PMC

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