A Case of Acute Median Arcuate Ligament Syndrome Manifesting after Total Pancreatectomy

Abstract

A 52-year-old man presented to a previous hospital with abdominal pain that was diagnosed as pancreatitis. His symptoms improved initially but recurred after one month. The patient was diagnosed with invasive pancreatic ductal adenocarcinoma and underwent preoperative chemotherapy. A total pancreatectomy was performed ; however, liver dysfunction progressed immediately after surgery. An emergency computed tomography scan showed poor contrast enhancement of the liver and gastric wall. The branching angles of the celiac artery trunk and superior mesenteric artery were shifted cephalically compared to the preoperative images. We presume that because of cephalad displacement, celiac axis stenosis (CAS) and median arcuate ligament syndrome (MALS) manifested. An emergency aortohepatic artery bypass was performed using the great saphenous vein. Hepatic and gastric blood flow improved, and the patient was discharged on the 29th postoperative day.

In this case, there was asymptomatic MALS according to the preoperative images, which should have been considered. Herein, we present the treatment course and discuss the case.