Peyrottes A, Mariage D, Baqué P, Massalou D
Rockefeller University Department of Anatomy, Claude Bernard University of Lyon, Villeurbanne, France.
Acute Care Surgery Unit, Nice University Hospital, Pasteur 2 Hospital, Nice Sophia-Antipolis University, Nice, France.
Surg Radiol Anat. 2018 Apr;40(4):401-405. doi: 10.1007/s00276-017-1950-8. Epub 2017 Dec 5.
Median arcuate ligament (MAL) syndrome is a rare and poorly known cause of abdominal pain. MAL narrows the celiac artery (CA), resulting in true distal aneurysms, including pancreaticoduodenal artery (PDA) aneurysms. These aneurysms often have an aggressive course, as rupture can result in hemorrhagic shock. CT scan appears to be the most effective investigation for the diagnosis of PDA aneurysms and may reveal possible celiac artery compression. In this series, we describe four cases of PDA aneurysm: two ruptured aneurysms treated by an endovascular procedure and two non-ruptured aneurysms treated by surgery. It was also decided to treat CA stenosis in three of the four patients based on the clinical presentation (ruptured or non-ruptured) and the presence of peripancreatic collateral vessels on imaging. This strategy contrasts with the approach commonly reported in the literature, in which MAL section is mandatory due to the high risk of ischemia rather than the potential risk of recurrent aneurysm. Medical teams should be aware of this disease to improve diagnosis and patient management.
正中弓状韧带（MAL）综合征是一种罕见且鲜为人知的腹痛病因。MAL使腹腔干（CA）变窄，导致真性远端动脉瘤，包括胰十二指肠动脉（PDA）动脉瘤。这些动脉瘤通常病程凶险，因为破裂可导致失血性休克。CT扫描似乎是诊断PDA动脉瘤最有效的检查方法，且可能显示腹腔干受压情况。在本系列中，我们描述了4例PDA动脉瘤：2例破裂动脉瘤通过血管内介入治疗，2例未破裂动脉瘤通过手术治疗。还根据临床表现（破裂或未破裂）以及影像学上胰周侧支血管的存在情况，决定对4例患者中的3例进行CA狭窄治疗。这一策略与文献中通常报道的方法不同，文献中由于缺血风险高而非复发性动脉瘤的潜在风险，通常强制进行MAL切断术。医疗团队应了解这种疾病，以改善诊断和患者管理。
