Takagi Toru, Morita Yoshifumi, Matsumoto Akio, Ida Shinya, Muraki Ryuta, Kitajima Ryo, Furuhashi Satoru, Takeda Makoto, Kikuchi Hirotoshi, Hiramatsu Yoshihiro, Takeuchi Hiroya
Department of Surgery, Hamamatsu University School of Medicine, 1-20-1 Handayama, Higashi-ku, Hamamatsu, 431-3192, Japan.
Division of Surgical Care, Morimachi, Hamamatsu University School of Medicine, Hamamatsu, 1-20-1 Handayama, Chuo-ku, 431-3192, Japan.
Surg Case Rep. 2024 Feb 15;10(1):41. doi: 10.1186/s40792-024-01817-w.
Median arcuate ligament compression syndrome (MALS) causes upper abdominal pain and at times hemodynamic abnormalities in the pancreaticoduodenal region. Herein, we present a case of a 70 year-old man, initially diagnosed with splenic infarction and was successfully treated laparoscopically.
A 70-year-old man with abdominal pain admitted to our hospital. Abdominal-enhanced computed tomography revealed a poorly contrasted area in the spleen and stenosis at the root of the celiac artery. Arterial dilatation was observed around the pancreaticoduodenal arcade, however, no obvious aneurysm formation or arterial dissection was observed. Abdominal-enhanced magnetic resonance imaging indicated the disappearance of the flow void at the root of the celiac artery. The patient had no history of atrial fibrillation and was diagnosed with splenic infarction due to median arcuate ligament compression syndrome. We performed a laparoscopic median arcuate ligament section with five ports. Intraoperative ultrasonography showed a retrograde blood flow in the common hepatic artery and the celiac artery. After releasing the compression, the antegrade blood flow from the celiac artery to the splenic artery, and the common hepatic artery were visualized using intraoperative ultrasonography. The postoperative course of the patient was uneventful, and he was discharged on postoperative day 9. Postoperative computed tomography a month after surgery revealed no residual stenosis of the celiac artery or dilation of the pancreaticoduodenal arcade. Furthermore, the poorly contrasted area of the spleen improved.
Reports indicate that hemodynamic changes in the abdominal visceral arteries due to median arcuate ligament compression are related to the formation of pancreaticoduodenal aneurysms. In this case, median arcuate ligament compression syndrome caused splenic infarction by reducing blood flow to the splenic artery.
正中弓状韧带压迫综合征（MALS）可导致上腹部疼痛，有时还会引起胰十二指肠区域的血流动力学异常。在此，我们报告一例70岁男性患者，最初被诊断为脾梗死，经腹腔镜手术成功治疗。
一名70岁男性因腹痛入院。腹部增强计算机断层扫描显示脾脏有一个对比度差的区域，腹腔干根部狭窄。在胰十二指肠动脉弓周围观察到动脉扩张，但未观察到明显的动脉瘤形成或动脉夹层。腹部增强磁共振成像显示腹腔干根部血流信号消失。该患者无房颤病史，诊断为正中弓状韧带压迫综合征导致的脾梗死。我们通过五个端口进行了腹腔镜正中弓状韧带切断术。术中超声显示肝总动脉和腹腔干有逆行血流。解除压迫后，术中超声显示腹腔干至脾动脉和肝总动脉的顺行血流。患者术后恢复顺利，术后第9天出院。术后1个月的计算机断层扫描显示腹腔干无残余狭窄，胰十二指肠动脉弓无扩张。此外，脾脏对比度差的区域有所改善。
报告表明，正中弓状韧带压迫引起的腹部内脏动脉血流动力学变化与胰十二指肠动脉瘤的形成有关。在本病例中，正中弓状韧带压迫综合征通过减少脾动脉血流导致脾梗死。
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