2021 Volume 41 Issue 6 Pages 449-452
There are some reports of cases of aneurysm associated with median arcuate ligament syndrome（MALS）, however, cases of hemorrhagic duodenal ulcer in such cases are rare. A 58-year-old man visited a neighborhood clinic with a history of hematemesis. Upper gastrointestinal endoscopy revealed intractable bleeding from a duodenal ulcer and emergency laparotomy with omental plombage was performed. However, the hemorrhage recurred and the patient was transferred to our hospital. Abdominal CT revealed a gastroduodenal artery aneurysm near the ulcer, which was thought to be the actual source of the bleeding. Therefore, coil embolization was performed as an emergency interventional radiologic（IVR）procedure and was successful. The patient was diagnosed as having MALS by the detection of stenosis at the origin of the celiac artery. Therefore, median arcuate ligament release was performed 3 months later, and the bleeding has not recurred since. Based on this experience, we wish to emphasize that it is important to be alert to the possibility of MALS in patients presenting with an intractable hemorrhagic duodenal ulcer and IVR should be performed immediately when MALS is detected.
