Obstructive jaundice as a rare complication of multiple pancreaticoduodenal artery aneurysms due to median arcuate ligament syndrome: a case report and review of the literature
Abstract Background Obstructive jaundice has various causes, and one of the rarest is pancreaticoduodenal artery aneurysm (PDAA), which is often associated with celiac axis stenosis caused by median arcuate ligament syndrome (MALS). Case presentation The patient was a 77-year-old Azeri woman who pre...
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| Format: | Article |
| Language: | English |
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BMC
2023-09-01
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| Series: | Journal of Medical Case Reports |
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| Online Access: | https://doi.org/10.1186/s13256-023-04114-6 |
| _version_ | 1797559485136371712 |
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| author | Javad Jalili Reza Javadrashid Dara Alvandfar Masih Falahatian Ali Jafarizadeh Samin Alihosseini Seyedeh Elnaz Hashemizadeh |
| author_facet | Javad Jalili Reza Javadrashid Dara Alvandfar Masih Falahatian Ali Jafarizadeh Samin Alihosseini Seyedeh Elnaz Hashemizadeh |
| author_sort | Javad Jalili |
| collection | DOAJ |
| description | Abstract Background Obstructive jaundice has various causes, and one of the rarest is pancreaticoduodenal artery aneurysm (PDAA), which is often associated with celiac axis stenosis caused by median arcuate ligament syndrome (MALS). Case presentation The patient was a 77-year-old Azeri woman who presented with progressive jaundice, vague abdominal pain, and abdominal distension from 6 months ago. The intra- and extrahepatic bile ducts were dilated, the liver's margin was slightly irregular, and the echogenicity of the liver was mildly heterogeneous in the initial ultrasound exam. A huge cystic mass with peripheral calcification and compressive effect on the common bile duct (CBD) was also seen near the pancreatic head, which was connected to the superior mesenteric artery (SMA) and had internal turbulent blood flow on color Doppler ultrasound. According to the computed tomography angiography (CTA) findings, the huge mass of the pancreatic head was diagnosed as a true aneurysm of the pancreaticoduodenal artery caused by MALS. Two similar smaller aneurysms were also present at the huge aneurysm's superior margin. Due to impending rupture signs in the huge aneurysm, the severe compression effect of this aneurysm on CBD, and the patient's family will surgery was chosen for the patient to resect the aneurysms, but unfortunately, the patient died on the first day after the operation due to hemorrhagic shock. Conclusion In unexpected obstructive jaundice due to a mass with vascular origin in the head of the pancreas, PDAA should be considered, and celiac trunk should be evaluated because the main reason for PDAA is celiac trunk stenosis or occlusion by atherosclerosis or MALS. The treatment method chosen (including transarterial embolization, open surgery, or combined method) depends on the patient's clinical status and radiological findings, but transarterial embolization would be safer and should be used as a first-line method. |
| first_indexed | 2024-03-10T17:46:04Z |
| format | Article |
| id | doaj.art-a132bb6f50a0452fad440b43b4183a32 |
| institution | Directory Open Access Journal |
| issn | 1752-1947 |
| language | English |
| last_indexed | 2024-03-10T17:46:04Z |
| publishDate | 2023-09-01 |
| publisher | BMC |
| record_format | Article |
| series | Journal of Medical Case Reports |
| spelling | doaj.art-a132bb6f50a0452fad440b43b4183a322023-11-20T09:32:09ZengBMCJournal of Medical Case Reports1752-19472023-09-0117111210.1186/s13256-023-04114-6Obstructive jaundice as a rare complication of multiple pancreaticoduodenal artery aneurysms due to median arcuate ligament syndrome: a case report and review of the literatureJavad Jalili0Reza Javadrashid1Dara Alvandfar2Masih Falahatian3Ali Jafarizadeh4Samin Alihosseini5Seyedeh Elnaz Hashemizadeh6Medical Radiation Sciences Research Group, Tabriz University of Medical SciencesMedical Radiation Sciences Research Group, Tabriz University of Medical SciencesDepartment of General Surgery, Emam Reza Hospital, Faculty of Medicine, Tabriz University of Medical SciencesMedical Radiation Sciences Research Group, Tabriz University of Medical SciencesStudent Research Committee, Tabriz University of Medical SciencesMedical Radiation Sciences Research Group, Tabriz University of Medical SciencesDepartment of Surgical and Clinical Pathology, Emam Reza Hospital, Tabriz University of Medical SciencesAbstract Background Obstructive jaundice has various causes, and one of the rarest is pancreaticoduodenal artery aneurysm (PDAA), which is often associated with celiac axis stenosis caused by median arcuate ligament syndrome (MALS). Case presentation The patient was a 77-year-old Azeri woman who presented with progressive jaundice, vague abdominal pain, and abdominal distension from 6 months ago. The intra- and extrahepatic bile ducts were dilated, the liver's margin was slightly irregular, and the echogenicity of the liver was mildly heterogeneous in the initial ultrasound exam. A huge cystic mass with peripheral calcification and compressive effect on the common bile duct (CBD) was also seen near the pancreatic head, which was connected to the superior mesenteric artery (SMA) and had internal turbulent blood flow on color Doppler ultrasound. According to the computed tomography angiography (CTA) findings, the huge mass of the pancreatic head was diagnosed as a true aneurysm of the pancreaticoduodenal artery caused by MALS. Two similar smaller aneurysms were also present at the huge aneurysm's superior margin. Due to impending rupture signs in the huge aneurysm, the severe compression effect of this aneurysm on CBD, and the patient's family will surgery was chosen for the patient to resect the aneurysms, but unfortunately, the patient died on the first day after the operation due to hemorrhagic shock. Conclusion In unexpected obstructive jaundice due to a mass with vascular origin in the head of the pancreas, PDAA should be considered, and celiac trunk should be evaluated because the main reason for PDAA is celiac trunk stenosis or occlusion by atherosclerosis or MALS. The treatment method chosen (including transarterial embolization, open surgery, or combined method) depends on the patient's clinical status and radiological findings, but transarterial embolization would be safer and should be used as a first-line method.https://doi.org/10.1186/s13256-023-04114-6JaundiceSuperior mesenteric arteryPancreaticoduodenal artery aneurysmMedian arcuate ligament syndromeCommon bile ductComputed tomography angiography |
| spellingShingle | Javad Jalili Reza Javadrashid Dara Alvandfar Masih Falahatian Ali Jafarizadeh Samin Alihosseini Seyedeh Elnaz Hashemizadeh Obstructive jaundice as a rare complication of multiple pancreaticoduodenal artery aneurysms due to median arcuate ligament syndrome: a case report and review of the literature Journal of Medical Case Reports Jaundice Superior mesenteric artery Pancreaticoduodenal artery aneurysm Median arcuate ligament syndrome Common bile duct Computed tomography angiography |
| title | Obstructive jaundice as a rare complication of multiple pancreaticoduodenal artery aneurysms due to median arcuate ligament syndrome: a case report and review of the literature |
| title_full | Obstructive jaundice as a rare complication of multiple pancreaticoduodenal artery aneurysms due to median arcuate ligament syndrome: a case report and review of the literature |
| title_fullStr | Obstructive jaundice as a rare complication of multiple pancreaticoduodenal artery aneurysms due to median arcuate ligament syndrome: a case report and review of the literature |
| title_full_unstemmed | Obstructive jaundice as a rare complication of multiple pancreaticoduodenal artery aneurysms due to median arcuate ligament syndrome: a case report and review of the literature |
| title_short | Obstructive jaundice as a rare complication of multiple pancreaticoduodenal artery aneurysms due to median arcuate ligament syndrome: a case report and review of the literature |
| title_sort | obstructive jaundice as a rare complication of multiple pancreaticoduodenal artery aneurysms due to median arcuate ligament syndrome a case report and review of the literature |
| topic | Jaundice Superior mesenteric artery Pancreaticoduodenal artery aneurysm Median arcuate ligament syndrome Common bile duct Computed tomography angiography |
| url | https://doi.org/10.1186/s13256-023-04114-6 |
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