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Median Arcuate Ligament Syndrome: an Important Consideration in Pancreaticoduodenectomy

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Abstract

Pancreaticoduodenectomy (PD) is a common surgery performed with curative intent for periampullary and pancreatic head neoplasms. In the presence of intrinsic celiac artery narrowing due to atherosclerosis or extrinsic compression due to median arcuate ligament syndrome (MALS), division of the gastroduodenal artery during PD can result in liver ischemia. This report describes a patient who had MALS which was treated by intraoperative median arcuate ligament release during PD, resulting in restoration of hepatic artery pulsations. Preventive, management strategies for MALS and the communicating vascular arcades between the celiac and superior mesenteric arterial systems are discussed in the context of PD.

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Authors and Affiliations

  1. Department of Surgical Gastroenterology & Liver Transplantation, Institute of Digestive & HPB Sciences, Sakra World Hospital, SY No.52/2 & 52/3, Devarabeesanahalli, Oppsite Intel, VarthurHobli, Bengaluru, Karnataka, 560103, India

    Gayatri Balachandran, Kishore G. S. Bharathy & Sadiq S. Sikora

Authors
  1. Gayatri Balachandran
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  2. Kishore G. S. Bharathy
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  3. Sadiq S. Sikora
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Contributions

Kishore GS Bharathy and Sadiq S Sikora contributed to the study conception and design. Material preparation and data collection were performed by Gayatri Balachandran. The first draft of the manuscript was written by Kishore GS Bharathy and Gayatri Balachandran. Sadiq S Sikora revised it for important intellectual content. All authors read and approved the final version of the manuscript.

Corresponding author

Correspondence to Sadiq S. Sikora.

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Ethics committee approval was waived as the procedures being performed were part of the routine care. Patient’s identity is not revealed in any of the images.

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The authors declare no competing interests.

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Balachandran, G., Bharathy, K.G.S. & Sikora, S.S. Median Arcuate Ligament Syndrome: an Important Consideration in Pancreaticoduodenectomy. Indian J Surg Oncol 12, 439–441 (2021). https://doi.org/10.1007/s13193-021-01308-6

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  • DOI: https://doi.org/10.1007/s13193-021-01308-6

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