Richards Nathan G, Neville Richard F, Sidawy Anton N, Brody Fredrick J
Department of Surgery, The George Washington University Medical Center, Washington, DC.
Surg Laparosc Endosc Percutan Tech. 2014 Apr;24(2):e66-9. doi: 10.1097/SLE.0b013e31828f70e0.
Median arcuate ligament (MAL) syndrome or celiac artery compression occurs secondary to diaphragmatic compression of the celiac artery and the corresponding neural structures of the celiac plexus. Typically, patients present with postprandial abdominal pain, nausea, vomiting, and weight loss. Diagnostically, various radiologic studies are used to document impingement of the celiac artery including ultrasound, computed tomography, aortograms, and magnetic resonance imaging. Historically, open approaches to the aorta and the celiac artery are performed to release the MAL and relieve compression of the celiac artery and the plexus. Laparoscopic approaches are now utilized to divide the MAL. This study describes a patient who underwent a successful laparoscopic Roux-en-Y gastric bypass and lost 100 lbs over a 2-year postoperative period. Subsequently, the patient developed postprandial abdominal pain associated with nausea. She underwent a computed tomogram that diagnosed celiac compression and then a dynamic ultrasound that showed elevated velocities with deep expiration. Ultimately, a laparoscopic MAL release with division of the celiac plexus was performed. At 10 months postoperatively, the patient remains asymptomatic. To our knowledge, this report documents a rare case of CAC after Roux-en-Y gastric bypass. On the basis of this report, CAC should be considered in the differential diagnosis of postprandial abdominal pain in patients after bariatric surgery.
正中弓状韧带（MAL）综合征或腹腔干压迫继发于腹腔干及腹腔丛相应神经结构受膈肌压迫。通常，患者表现为餐后腹痛、恶心、呕吐及体重减轻。在诊断方面，多种放射学检查用于记录腹腔干受压情况，包括超声、计算机断层扫描、主动脉造影和磁共振成像。过去，通过开放手术处理主动脉和腹腔干以松解正中弓状韧带并缓解腹腔干及神经丛受压。现在采用腹腔镜手术来切断正中弓状韧带。本研究描述了一名患者，该患者成功接受了腹腔镜Roux-en-Y胃旁路手术，术后2年体重减轻了100磅。随后，该患者出现了与恶心相关的餐后腹痛。她接受了计算机断层扫描，诊断为腹腔干受压，随后进行了动态超声检查，结果显示深呼气时血流速度升高。最终，实施了腹腔镜正中弓状韧带松解术并切断腹腔丛。术后10个月，患者仍无症状。据我们所知，本报告记录了Roux-en-Y胃旁路术后罕见的腹腔干压迫病例。基于本报告，在肥胖症手术后餐后腹痛的鉴别诊断中应考虑腹腔干压迫。
