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European Surgery

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01-10-2016 | Case Report

Celiac artery compression of patients undergoing pancreatic surgery – a case series

Authors: A. Pötscher, MD, F. Längle, MD

Published in: European Surgery | Issue 5/2016

Summary

Background

Celiac artery compression due to the median arcuate ligament is a rare but not an uncommon finding in patients undergoing pancreaticoduodenectomy (PD). Due to the interruption of the collateral pathways during surgery, celiac artery compression may be associated with fatal complications.

Case reports

In this paper, we present three patients with celiac artery compression undergoing PD. In the first case, celiac artery compression was recognized during surgery, but nevertheless the patient died postoperatively because of ongoing Klebsiella sepsis. In the second case, we did not recognize it during initial surgery so further complications could have been avoided. In the third case, compression was detected during PD and the postoperative course was without complications.

Conclusion

Preoperative abdominal CT scan should be evaluated very carefully in order to identify celiac artery compression. Otherwise absence or limitation of blood flow within the common hepatic artery (CHA) during surgery should lead surgeon to suspect presence of compression of the celiac artery.

Muqeetadnan M, Syed A, Rahman A, Nusrat S, Hassan S. Celiac artery Compression Syndrome. Case Rep Gastrointest Med. 2013;2013:Article ID 934052.

Baskan Ö, Özdenkaya Y, Cengiz E, Dolay K. Problems with the median arcuate ligament should be recognized before surgery; its importance in pancreaticoduodenectomy. Balkan Med J. 2015;32:312–5.CrossRefPubMedPubMedCentral

Peros G, Sakorafas GH, Giannopoulos GA, Manikis D, Vassiliu P, Brountzos EN. Successful Panreaticoduodenectomy with immediate vascular reconstrucion in a patient with cancer of the pancreatic head and celiac artery stenosis. A case report. J Pancreas. 2009;10(6):667–70.

Horton KM, Talamini MA, Fishman EK. Median arcuate ligament syndrome: evaluation with CT angiography. Radiographics. 2005;25(5):1177–82.CrossRefPubMed

Carey P, Stemmer EA, Connolly JE. Median arcuate ligament syndrome experimental and clinical observations. Arch Surg. 1969;99(4):441–6. doi:10.1001/archsurg.1969.01340160021005..CrossRefPubMed

Dunbar JD, Molnar W, Beman FF, Marable SA. Compression of the celiac trunk and abdominal angina. Am J Roentgenol Radium Ther Nucl Med. 1965;95(3):731–44.CrossRefPubMed

Sturiale A, Alemanno G, Giudici F, Addasi R, Bellucci F, Tonelli F. Median arcuate ligament syndrome in a patient with Crohn’s disease. Int J Surg Case Rep. 2013;4(4):399–394.CrossRefPubMedPubMedCentral

Scovell S, Hamdan A. Celiac artery compression syndrome. UpToDate. 2015;8204. http://www.uptodate.com/contents/celiac-artery-compression-syndrome

Okten RS, Kucukay F, Tola M, Bostanci B, Cumhur T. Is celiac artery compression syndrome genetically inherited? A case series from a family and review of the literature. Eur J Radiol. 2012;81(6):1089–93.CrossRefPubMed

10.

Bech F, Loesberg A, Rosenblum J, Glagov S, Gewertz BL. Median arcuate ligament compression syndrome in monozygotic twins. J Vasc Surg. 1994;19(5):934–8.CrossRefPubMed

11.

Lachowska-Kotowska P, Prystupa A, Kurys-Denis E, Kęsik JJ, Opielak G, Kupis Z, Krupski W, Zubilewicz T, Maciejewski R, Mosiewicz J. Chronic abdominal pain caused by stenosis of celiac trunk – case report. J Preclin Clin Res. 2010;4(2):168–70.

12.

Duncan AA. Median arcuate ligament syndrome. Curr Treat Options Cardiovasc Med. 2008;10(2):112–6. doi:10.1007/s11936-008-0012-2.CrossRefPubMed

13.

Gruber H, Loizides A, Peer S, Gruber I. Ultrasound of the median arcuate ligament syndrome: a new approach to diagnosis. Med Ultrason. 2012;14:5–9.PubMed

14.

Sharafuddin MJ, Olson CH, Sun S, Kresowik TF, Corson JD. Endovascular treatment of celiac and mesenteric arteries stenoses: applications and results. J Vasc Surg. 2003;38(4):692–8.CrossRefPubMed

15.

Delis KT, Gloviczki P, Altuwaijri M. Median arcuate ligament syndrome: open celiac artery reconstruction and ligament division after endovascular failure. J Vasc Surg. 2007;46(4):799–802.CrossRefPubMed

16.

Shukla PJ, Barreto SG, Kulkarni A, Nagarajan G, Fingerhut A. Vascular anomalies encountered during pancreatoduodenectomy: Do they influence outcomes? Ann Surg Oncol. 2010;17:186–93.CrossRefPubMed

17.

Song S‑Y, Chung JW, Kwon JW, Joh JH, Shin SJ, Kim HB, Park JH. Collateral pathways in patients with celiac axis stenosis: angiographic-spiral CT correlation. Radiographics. 2002;22:881–93.CrossRefPubMed

Title: Celiac artery compression of patients undergoing pancreatic surgery – a case series
Authors: A. Pötscher, MD
F. Längle, MD
Publication date: 01-10-2016
Publisher: Springer Vienna
Published in: European Surgery / Issue 5/2016
Print ISSN: 1682-8631
Electronic ISSN: 1682-4016
DOI: https://doi.org/10.1007/s10353-016-0443-z

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Celiac artery compression of patients undergoing pancreatic surgery – a case series

Summary

Background

Case reports

Conclusion

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Summary

Background

Case reports

Conclusion

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