Management of median arcuate ligament syndrome in patients who require pancreaticoduodenectomy

Whistance, Robert N., Shah, Vallari, Grist, Emily R., Shearman, Clifford P, Pearce, Neil W., Odurny, Allan, Stedman, Brian and Johnson, Colin D. (2011) Management of median arcuate ligament syndrome in patients who require pancreaticoduodenectomy. Annals of The Royal College of Surgeons of England, 93, (4), 11E-14E. (doi:10.1308/003588411X13008915740787). (PMID:21944786).


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Pancreaticoduodenectomy is the standard treatment for localised neoplasms of the pancreatic head. The operation can be performed safely in specialist units but good outcome is compromised if postoperative blood flow to the liver and biliary tree is inadequate. Coeliac artery occlusion with blood supply to the liver arising from the superior mesenteric artery via the gastroduodenal artery is difficult to recognise, especially intraoperatively. Recognition of absent hepatic artery pulsation after occlusion of the gastroduodenal artery opens a dilemma: should the resection be abandoned or should vascular reconstruction be undertaken, adding risk to an already complex procedure? We describe two cases with a resectable pancreatic endocrine tumour in which coeliac artery occlusion caused by median arcuate ligament compression was identified from cross-sectional imaging and reconstructions. We highlight two different strategies to correct the vascular insufficiency and allow safe pancreatic resection.

Item Type: Article
Digital Object Identifier (DOI): doi:10.1308/003588411X13008915740787
ISSNs: 0035-8843 (print)
1478-7083 (electronic)
Subjects: R Medicine > RC Internal medicine > RC0254 Neoplasms. Tumors. Oncology (including Cancer)
Divisions : Faculty of Medicine > Cancer Sciences
ePrint ID: 202963
Accepted Date and Publication Date:
May 2011Published
Date Deposited: 10 Nov 2011 11:57
Last Modified: 31 Mar 2016 13:46

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