Laparoscopic treatment in a patient with median arcuate ligament syndrome identified at the onset of superior mesenteric artery dissection: a case report
Abstract Background Median arcuate ligament syndrome (MALS) is a rare clinical entity caused mainly by extrinsic compression of the celiac axis by the median arcuate ligament (MAL). Severe celiac artery stenosis can lead to the development of collateral circulation, aneurysms, and, rarely, superior...
| Main Authors: | , , , , , , , |
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| Format: | Article |
| Language: | English |
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SpringerOpen
2019-12-01
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| Series: | Surgical Case Reports |
| Subjects: | |
| Online Access: | https://doi.org/10.1186/s40792-019-0758-7 |
| _version_ | 1818929271416029184 |
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| author | Haruhiko Okada Kazuhisa Ehara Hisashi Ro Masaki Yamada Tetsuya Saito Naoki Negami Yasunori Ishido Masahiko Sato |
| author_facet | Haruhiko Okada Kazuhisa Ehara Hisashi Ro Masaki Yamada Tetsuya Saito Naoki Negami Yasunori Ishido Masahiko Sato |
| author_sort | Haruhiko Okada |
| collection | DOAJ |
| description | Abstract Background Median arcuate ligament syndrome (MALS) is a rare clinical entity caused mainly by extrinsic compression of the celiac axis by the median arcuate ligament (MAL). Severe celiac artery stenosis can lead to the development of collateral circulation, aneurysms, and, rarely, superior mesenteric artery (SMA) dissection. The treatment of MALS involves the surgical release of the MAL. However, a standard procedure with the use of laparoscopy has not been established, and intraoperative complications can lead to severe vascular injury. Case presentation The patient was a 43-year-old man with MALS identified at the onset of SMA dissection. After treatment for the SMA dissection, he underwent laparoscopic MAL release. Using the technique of laparoscopic gastrectomy within the surgical field, we performed laparoscopic MAL release and ganglionectomy safely with a good view. Immediate symptomatic improvement was acquired, and no recurrence was observed at the 20-month follow-up. Conclusion We reported a rare case of MALS and SMA dissection. A horizontal 3D laparoscopic approach of the celiac axis allows for safe, meticulous, and radical MAL release and ganglionectomy. |
| first_indexed | 2024-12-20T03:42:09Z |
| format | Article |
| id | doaj.art-26a34ffa0a374348be966c9034619756 |
| institution | Directory Open Access Journal |
| issn | 2198-7793 |
| language | English |
| last_indexed | 2024-12-20T03:42:09Z |
| publishDate | 2019-12-01 |
| publisher | SpringerOpen |
| record_format | Article |
| series | Surgical Case Reports |
| spelling | doaj.art-26a34ffa0a374348be966c90346197562022-12-21T19:54:43ZengSpringerOpenSurgical Case Reports2198-77932019-12-01511510.1186/s40792-019-0758-7Laparoscopic treatment in a patient with median arcuate ligament syndrome identified at the onset of superior mesenteric artery dissection: a case reportHaruhiko Okada0Kazuhisa Ehara1Hisashi Ro2Masaki Yamada3Tetsuya Saito4Naoki Negami5Yasunori Ishido6Masahiko Sato7Department of Surgery, Saiseikai Kawaguchi General HospitalDivision of Gastroenterological Surgery, Saitama Cancer CenterDepartment of Surgery, Saiseikai Kawaguchi General HospitalDepartment of Surgery, Saiseikai Kawaguchi General HospitalDepartment of Surgery, Saiseikai Kawaguchi General HospitalDepartment of Surgery, Saiseikai Kawaguchi General HospitalDepartment of Surgery, Saiseikai Kawaguchi General HospitalDepartment of Surgery, Saiseikai Kawaguchi General HospitalAbstract Background Median arcuate ligament syndrome (MALS) is a rare clinical entity caused mainly by extrinsic compression of the celiac axis by the median arcuate ligament (MAL). Severe celiac artery stenosis can lead to the development of collateral circulation, aneurysms, and, rarely, superior mesenteric artery (SMA) dissection. The treatment of MALS involves the surgical release of the MAL. However, a standard procedure with the use of laparoscopy has not been established, and intraoperative complications can lead to severe vascular injury. Case presentation The patient was a 43-year-old man with MALS identified at the onset of SMA dissection. After treatment for the SMA dissection, he underwent laparoscopic MAL release. Using the technique of laparoscopic gastrectomy within the surgical field, we performed laparoscopic MAL release and ganglionectomy safely with a good view. Immediate symptomatic improvement was acquired, and no recurrence was observed at the 20-month follow-up. Conclusion We reported a rare case of MALS and SMA dissection. A horizontal 3D laparoscopic approach of the celiac axis allows for safe, meticulous, and radical MAL release and ganglionectomy.https://doi.org/10.1186/s40792-019-0758-7Median arcuate ligament syndromeSuperior mesenteric artery dissectionLaparoscopy |
| spellingShingle | Haruhiko Okada Kazuhisa Ehara Hisashi Ro Masaki Yamada Tetsuya Saito Naoki Negami Yasunori Ishido Masahiko Sato Laparoscopic treatment in a patient with median arcuate ligament syndrome identified at the onset of superior mesenteric artery dissection: a case report Surgical Case Reports Median arcuate ligament syndrome Superior mesenteric artery dissection Laparoscopy |
| title | Laparoscopic treatment in a patient with median arcuate ligament syndrome identified at the onset of superior mesenteric artery dissection: a case report |
| title_full | Laparoscopic treatment in a patient with median arcuate ligament syndrome identified at the onset of superior mesenteric artery dissection: a case report |
| title_fullStr | Laparoscopic treatment in a patient with median arcuate ligament syndrome identified at the onset of superior mesenteric artery dissection: a case report |
| title_full_unstemmed | Laparoscopic treatment in a patient with median arcuate ligament syndrome identified at the onset of superior mesenteric artery dissection: a case report |
| title_short | Laparoscopic treatment in a patient with median arcuate ligament syndrome identified at the onset of superior mesenteric artery dissection: a case report |
| title_sort | laparoscopic treatment in a patient with median arcuate ligament syndrome identified at the onset of superior mesenteric artery dissection a case report |
| topic | Median arcuate ligament syndrome Superior mesenteric artery dissection Laparoscopy |
| url | https://doi.org/10.1186/s40792-019-0758-7 |
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