Abstract
We report a case of an aneurysm of the dorsal pancreatic artery associated with the median arcuate ligament (MAL) syndrome. A 31-year-old woman, who had been on medication with oral estrogen in an irregular basis for premature menopause since the age of 17, was reffered to our hospital because of epigastralgia and a liver tumor, 5cm in diameter, on ultrasonography. A diagnostic abdominal angiography revealed celiac axis compression by MAL and an aneurysm, 5mm in diameter, of the dorsal pancreatic artery. The liver tumor was diagnosed as hemangioma based on findings of MRI and CT during angiography. Considering difficulties in the embolization because of the proximity of the aneurysm to the root of the superior mesenteric artery, the section of MAL under laparotomy was performed to release the celiac compression. The hepatic hemangioma was concominantly resected. The shrinkage of the aneurysm and patency of the celiac artery were confirmed by angiography and MDCT during follow-up surveys.
The main cause of aneurysms in the pancreato-duodenal area is supposed to be due to increased blood flow of the peri-pancreatic artery to compensate decreased celiac flow. Therefore, release of the celiac compression by the section of MAL should be considered when direct surgical approach or interventional radiologic therapy against the aneurysm in the peri-pancreatic area is difficult.
