膵十二指腸動脈瘤破裂に対してTAE施行後に腹腔鏡下正中弓状靭帯切除を行った正中弓状靭帯圧迫症候群の1例

抄録

In recent years, narrowing of the root of the celiac artery has drawn attention as a cause of pancreaticoduodenal artery aneurysm. The median arcuate ligament (MAL) is formed by connecting the left crus of the diaphragm and the right crus anterior to the vertebral body, and vascular compression at this level can alter the hemodynamics of the celiac artery root resulting in aneurysms. We present the case of a 61-year-old man, who presented with abdominal pain. Abdominal aneurysms were found by CT, and transcatheter arterial embolization (TAE) was performed in the emergency department. The patient’s post-TAE course was uneventful and he was subsequently referred to our hospital for a surgical cure. We performed laparoscopic median arcuate ligamentectomy. Intraoperatively, strong binding connective tissue was found on the anterior surface of the celiac artery, which was dissected away. Antegrade hemodynamic flow was observed in the common hepatic artery on the CT image obtained on the seventh postoperative day. Anterior hemodynamic flow was also observed in the common hepatic artery, and the narrowing at the root of the celiac artery improved as well. In cases where selective TAE is successful, laparoscopic MAL resection may be an effective radical procedure.