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. 2019 Jul 1;2019(7):omz067.
doi: 10.1093/omcr/omz067.

Spontaneous bleeding of the inferior pancreatic-duodenal artery in median arcuate ligament syndrome: do not miss the diagnosis

Eleni Rebelos  1 , Alessandro Cipriano  1 , Laura Ferrini  1 , Silvia Trifirò  1 , Niccolò Napoli  2 , Massimo Santini  1 , Vinicio Napoli  3
Affiliations

Spontaneous bleeding of the inferior pancreatic-duodenal artery in median arcuate ligament syndrome: do not miss the diagnosis

Eleni Rebelos et al. Oxf Med Case Reports. .

Abstract

Median arcuate ligament syndrome (MALS) is a rare condition in which the median arcuate ligament (MAL) causes compression of the coeliac trunk. The chronic compression leads to coeliac trunk luminal narrowing and reduced blood supply to the abdominal splanchnic organs with possible local complications such as pseudo-aneurysms and spontaneous bleeding. Its incidence is probably underestimated due to the poor availability of color Doppler ultrasonography (CD-US), especially in an Emergency Department (ED) setting. A 44-year old woman presented to Pisa University Hospital ED with acute abdominal pain. An abdominal ultrasonography scan (US scan) was performed showing the presence of free liquid in the Douglas pouch. The abdominal computed tomography scan (CT scan) highlighted the presence of a large mesenteric hematoma. A CD-US revealed a significant stenosis of the coeliac artery. A selective angiography confirmed the diagnosis of MALS with a pseudo-aneurysm of the inferior pancreatic-duodenal artery, which was successfully embolized.

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Figures

Figure 1
Figure 1
CD-US indicating the PSVs in the coeliac artery (A) during maximum expiration and (B) during maximum inspiration.
See this image and copyright information in PMC

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