Resection and reconstruction of pancreatic artery aneurysms caused by the compression of the celiac trunk by the median arcuate ligament: a report of two cases

Hideaki Uchiyama; Sosei Kuma; Mayumi Ishida; Eiji Tsujita; Yoshinari Nobuto; Yuta Kasagi; Keita Natsugoe; Takehiko Aoyagi; Tomohiro Iguchi; Hiroyuki Itoh

doi:10.1186/s40792-021-01247-y

Resection and reconstruction of pancreatic artery aneurysms caused by the compression of the celiac trunk by the median arcuate ligament: a report of two cases

Surg Case Rep. 2021 Jul 16;7(1):167. doi: 10.1186/s40792-021-01247-y.

Authors

Affiliations

¹ Department of Surgery, National Hospital Organization Fukuokahigashi Medical Center, Koga, 811-3195, Japan. uchiyama.hideaki.bk@mail.hosp.go.jp.
² Department of Surgery, National Hospital Organization Fukuokahigashi Medical Center, Koga, 811-3195, Japan.
³ Department of Surgery, Saiseikai Fukuoka General Hospital, Fukuoka, 810-0001, Japan.

Abstract

Background: Some patients with the compression of the celiac trunk by the median arcuate ligament (MAL) suffer pancreatic artery aneurysms (PAAs) due to excessive blood flow from the superior mesenteric artery. These aneurysms are in peril because they are prone to rupture irrespective of size. Here, we present two cases of resection and reconstruction of PAAs caused by the compression of the celiac trunk by the MAL.

Case presentation: Patient 1 was a 44-year-old man who was first diagnosed to have a visceral artery aneurysm with a diameter of 4 cm accidentally found by ultrasound examination at a regular medical check-up. Contrast-enhanced CT revealed the compression of the celiac trunk by the MAL and a PAA originating from the first jejunal artery. First, laparoscopic excision of the MAL followed by a stent placement into the celiac trunk was performed. Although the stent was patent, the PAA still grew. The patient underwent resection and reconstruction of the PAA. Reconstruction of the pancreatic arterial arcade was needed because clamping of the inferior pancreaticoduodenal artery (IPDA) resulted in disappearance of the hepatic arterial blood flow. The follow-up CT 2 years and 9 months after the operation revealed no recurrence of aneurysms and the patent anastomosis. Patient 2 was a 68-year-old man who presented with an epigastric pain. Contrast-enhanced CT revealed the compression of the celiac trunk by the MAL and a PAA approximately 6 cm in diameter originating from the IPDA. The PAA was surrounded by a relatively low-intensity area, suggesting impending rupture of the PAA. The patient underwent resection and reconstruction of the PAA under an emergency situation. Reconstruction of the pancreatic arterial arcade was needed because clamping of the inflow IPDA resulted in disappearance of the hepatic blood flow. The follow-up CT 1 year and 8 months after the operation revealed no recurrence of aneurysms and the patent anastomosis.

Conclusions: Although long-term follow-up is needed, resection and reconstruction is one of the therapeutic choices for PAAs caused by the compression of the celiac trunk by the MAL in order to prevent catastrophic aneurysm rupture.

Keywords: Median arcuate ligament; Pancreatic artery aneurysm; Resection and reconstruction; Rupture.