Combined modality treatment of ruptured pancreaticoduodenal artery aneurysms due to celiac artery compression

Calkins, Casey M.; Moore, Ernest E.; Turner, James H.; Cothren, Clay C.; Burch, Jon M.

doi:10.1016/j.surg.2003.11.016

Cited by 12 publications

(8 citation statements)

References 4 publications

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“…Occasionally, patients may even present with renovascular hypertension that arises from a poststenotic dilatation that affects the renal arteries. 10 In addition to renovascular anatomic aberrancies, Calkins et al 11 showed that pancreaticoduodenal artery aneurysms may result from CAC and lead to further symptoms.…”

Section: Discussionmentioning

confidence: 99%

Celiac Artery Compression After a Gastric Bypass

Richards¹,

Neville²,

Sidawy³

et al. 2014

Surgical Laparoscopy, Endoscopy &Amp; Percutaneous Techniques

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Median arcuate ligament (MAL) syndrome or celiac artery compression occurs secondary to diaphragmatic compression of the celiac artery and the corresponding neural structures of the celiac plexus. Typically, patients present with postprandial abdominal pain, nausea, vomiting, and weight loss. Diagnostically, various radiologic studies are used to document impingement of the celiac artery including ultrasound, computed tomography, aortograms, and magnetic resonance imaging. Historically, open approaches to the aorta and the celiac artery are performed to release the MAL and relieve compression of the celiac artery and the plexus. Laparoscopic approaches are now utilized to divide the MAL. This study describes a patient who underwent a successful laparoscopic Roux-en-Y gastric bypass and lost 100 lbs over a 2-year postoperative period. Subsequently, the patient developed postprandial abdominal pain associated with nausea. She underwent a computed tomogram that diagnosed celiac compression and then a dynamic ultrasound that showed elevated velocities with deep expiration. Ultimately, a laparoscopic MAL release with division of the celiac plexus was performed. At 10 months postoperatively, the patient remains asymptomatic. To our knowledge, this report documents a rare case of CAC after Roux-en-Y gastric bypass. On the basis of this report, CAC should be considered in the differential diagnosis of postprandial abdominal pain in patients after bariatric surgery.

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Section: Discussionmentioning

confidence: 99%

Celiac Artery Compression After a Gastric Bypass

Richards¹,

Neville²,

Sidawy³

et al. 2014

Surgical Laparoscopy, Endoscopy &Amp; Percutaneous Techniques

View full text Add to dashboard Cite

show abstract

“…This is mainly due to difficulty in dealing with multiple small pancreatic communicating vessels, which can lead to major pancreatic resection being required (6). Radiological intervention is regarded as a safer and more effective alternative to surgery, but sometimes a combined approach is the only solution to such aneurysms (1,8). Mesenteric angiography with coil embolisation of the inferior pancreaticoduodenal artery aneurysm was successful in this patient.…”

Section: Discussionmentioning

confidence: 99%

Spontaneous haemoperitoneum caused by inferior pancreaticoduodenal artery aneurysm rupture: case report

Klass¹,

Forshaw²,

Gossage³

et al. 2007

International Journal of Clinical Practice

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“…The most common clinical presentation of an unruptured aneurysm is vague abdominal pain (Table 1). 4,7,8,[13][14][15][16][17][18][19][20][25][26][27][28][29][30][31][32][33][34][35][36][37] This may be related to extrinsic compression on the duodenum or pancreatic and biliary ducts. Jaundice as a presenting clinical symptom is rare.…”

Section: Clinical Presentationmentioning

confidence: 99%

“…Jaundice as a presenting clinical symptom is rare. 38 Patients may present with gastrointestinal bleeding, 13,29 probably secondary to rupture of the aneurysms into the duodenum and/or pancreatic duct. A few patients may present with acute abdominal pain and shock due to rupture of the aneurysm.…”

Section: Clinical Presentationmentioning

confidence: 99%

“…Neither recurrence of the aneurysms nor recurrent bleeding have been reported after successful occlusion of the aneurysms. 4,16,19,29,30 In addition to coils, other embolic agents (such as thrombin, N-acetyl cyanoacrylate, and Onyx 1 [Ev3 Endovascular, Inc., Plymouth, MN]) 4 have been used successfully for embolization. However, tortuosity of the inferior pancreaticoduodenal artery may present difficulties to selectively embolize the aneurysms.…”

Section: Treatmentmentioning

confidence: 99%

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