Laparoscopic decompression of a stricture of the celiac artery caused by the median arcuate ligament in a gastric cancer patient: A case of report

Asaumi, Yoshihide; Sakatoku, Mitsuaki; Okamoto, Junpei; Hayashi, Shin’ichiro; Ota, Naohiro; Yoshida, Kouichi; Sugahara, Hiroyuki; Tabata, Satoshi; Kaneki, Masahiro; Ietsugu, Kenichi; Kurisu, Kaoru

doi:10.1111/ases.12650

Cited by 2 publications

(1 citation statement)

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“…Likewise, the treatment for asymptomatic MALS in patients with gastric cancer who are indicated for surgery is also unknown. As far as we can find in PubMed, there is only one case of gastric cancer complicated with MALS, in which laparoscopic distal gastrectomy and median arch ligament release were performed simultaneously [8]. The patient in this literature was a 62-year-old woman with asymptomatic MALS who underwent median arch ligament release at the same time as her gastric cancer surgery because adhesions would make surgery difficult if surgery for MALS were needed after gastrectomy.…”

Section: Discussionmentioning

confidence: 99%

A case of laparoscopic distal gastrectomy and median arcuate ligament release for a gastric cancer patient with median arcuate ligament syndrome

et al. 2022

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Background The median arcuate ligament syndrome (MALS) is a disease in which the celiac artery is compressed by the arcuate ligament and causes stenosis. If abdominal pain or an aneurysm is observed in the head of the pancreas, it is necessary to release the arcuate ligament, and recently laparoscopic surgery has been reported. However, the indication for treatment in asymptomatic cases is unknown. The treatment for asymptomatic MALS in patients with gastric cancer who are indicated for surgery is also novel. Case presentation A 70-year-old female was found with early gastric cancer in the middle body of the stomach. An enhanced CT scan showed no metastasis, but a gallstone and stenosis of the celiac artery due to the MALS were found. The patient underwent releasing median arcuate ligament after lymph node dissection. A median arcuate ligament was located on the ventral side of the left gastric artery stump, and the celiac artery was exposed when cutting it off. The operation time was 4 h and 59 min, and the bleeding was 6 ml. It took about 5 min to dissect the medial arcuate ligament. The postoperative course was satisfactory, and the patient was discharged 7 days after the operation. CT scan and 3-D CT angiography were performed about 2 months after the operation, and the findings revealed that the celiac artery's stenosis resolved. Conclusion The patient underwent laparoscopic gastrectomy and simultaneously the median arcuate ligament release under an excellent visual field. Therefore, median arcuate ligament release may be considered if MALS is found in a gastrectomy case.

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Section: Discussionmentioning

confidence: 99%