Tokuda Satoshi, Sakuraba Shunsuke, Orita Hajime, Sakurada Mutsumi, Kushida Tomoyuki, Maekawa Hiroshi, Sato Koichi
Department of Surgery, Juntendo Shizuoka Hospital, Shizuoka, Japan.
Case Rep Surg. 2019 Jan 13;2019:1795653. doi: 10.1155/2019/1795653. eCollection 2019.
There are many possible causes of an abdominal visceral aneurysm, including the obstruction of the celiac artery by the median arcuate ligament (MAL). We report two cases of an aneurysm of the pancreaticoduodenal artery due to MAL syndrome that we treated surgically.
Case 1: a 66-year-old Japanese woman was diagnosed with a rupture of an aneurysm of the inferior pancreaticoduodenal artery. Because of the difficulty of endovascular therapy, we performed an emergency operation. We chose an abdominal operation, and the postoperative course was uneventful. Case 2: a 75-year-old Japanese man presented at our hospital with acute abdominal pain, nausea, and cold sweat. Our experience of treating MAL syndrome in case 1 enabled us to diagnose the disease accurately. We chose laparoscopic surgery, and the postoperative course was uneventful.
There are several treatment choices for an aneurysm of the pancreaticoduodenal artery due to MAL syndrome. We have performed only a release of the MAL for treatment, but it is difficult to conclude whether only releasing the MAL is enough to ensure a positive long-term prognosis. Regular follow-up is needed in such cases.
Laparoscopic surgery can be considered one of the options for MAL syndrome.
腹腔内脏动脉瘤有多种可能病因，包括正中弓状韧带（MAL）压迫腹腔干。我们报告两例因MAL综合征导致的胰十二指肠动脉瘤，均接受了手术治疗。
病例1：一名66岁日本女性被诊断为胰十二指肠下动脉瘤破裂。由于血管内治疗困难，我们进行了急诊手术。我们选择了开腹手术，术后恢复顺利。病例2：一名75岁日本男性因急性腹痛、恶心和冷汗前来我院就诊。我们在病例1中治疗MAL综合征的经验使我们能够准确诊断该疾病。我们选择了腹腔镜手术，术后恢复顺利。
对于因MAL综合征导致的胰十二指肠动脉瘤，有几种治疗选择。我们仅通过松解MAL进行治疗，但很难确定仅松解MAL是否足以确保长期预后良好。此类病例需要定期随访。
腹腔镜手术可被视为MAL综合征的治疗选择之一。
