Abstract
A 61-year-old woman was brought to the emergency room of our hospital with suspected retroperitoneal bleeding. Computed tomography (CT) showed a ruptured pancreaticoduodenal artery aneurysm and median arcuate ligament syndrome (MALS), and emergency interventional radiology (IVR) was performed the same day. Due to the risk of recurrent aneurysm formation and rupture, it was decided to perform arcuate ligament release, and the procedure was carried out in a hybrid operating room to assess perfusion and enable additional treatment following release of the ligament. The arcuate ligament was released, and decompression was achieved, but since some stenosis persisted, balloon dilatation was also performed. Postoperative CT showed that the stenosis of the celiac artery root and the dilatation of the arcade of the head of the pancreas had improved. Various different treatments for MALS have been reported, but treatment in a hybrid operating room, which enables real-time hemodynamic assessment, as well as the choice of other procedures such as balloon dilatation, is an effective option.
