Rebelos Eleni, Cipriano Alessandro, Ferrini Laura, Trifirò Silvia, Napoli Niccolò, Santini Massimo, Napoli Vinicio
U.O. Medicina d'Urgenza e Pronto Soccorso, Emergency Department, Azienda Ospedaliero-Universitaria Pisana, Pisa, Italy.
Division of General and Transplant Surgery, University of Pisa, Pisa, Italy.
Oxf Med Case Reports. 2019 Jul 1;2019(7). doi: 10.1093/omcr/omz067.
Median arcuate ligament syndrome (MALS) is a rare condition in which the median arcuate ligament (MAL) causes compression of the coeliac trunk. The chronic compression leads to coeliac trunk luminal narrowing and reduced blood supply to the abdominal splanchnic organs with possible local complications such as pseudo-aneurysms and spontaneous bleeding. Its incidence is probably underestimated due to the poor availability of color Doppler ultrasonography (CD-US), especially in an Emergency Department (ED) setting. A 44-year old woman presented to Pisa University Hospital ED with acute abdominal pain. An abdominal ultrasonography scan (US scan) was performed showing the presence of free liquid in the Douglas pouch. The abdominal computed tomography scan (CT scan) highlighted the presence of a large mesenteric hematoma. A CD-US revealed a significant stenosis of the coeliac artery. A selective angiography confirmed the diagnosis of MALS with a pseudo-aneurysm of the inferior pancreatic-duodenal artery, which was successfully embolized.
正中弓状韧带综合征（MALS）是一种罕见病症，其中正中弓状韧带（MAL）导致腹腔干受压。慢性压迫会导致腹腔干管腔狭窄以及腹部内脏器官的血液供应减少，并可能引发诸如假性动脉瘤和自发性出血等局部并发症。由于彩色多普勒超声检查（CD-US）的可及性较差，其发病率可能被低估，尤其是在急诊科（ED）环境中。一名44岁女性因急性腹痛就诊于比萨大学医院急诊科。进行了腹部超声扫描（US扫描），显示Douglas窝有游离液体。腹部计算机断层扫描（CT扫描）突出显示存在一个大的肠系膜血肿。CD-US显示腹腔动脉有明显狭窄。选择性血管造影证实了MALS的诊断，并伴有胰十二指肠下动脉假性动脉瘤，该假性动脉瘤已成功栓塞。
