Management of median arcuate ligament syndrome in patients who require pancreaticoduodenectomy
Management of median arcuate ligament syndrome in patients who require pancreaticoduodenectomy
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.
11E-14E
Whistance, Robert N.
3653139e-e6f4-437e-a299-ec01698a8fab
Shah, Vallari
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Grist, Emily R.
9a512ed8-6349-400f-b9d4-80b17fb0ca55
Shearman, Clifford P
cf4d6317-f54d-4ab3-ba49-c6797897bbcf
Pearce, Neil W.
6e450393-03db-472b-9231-1aa2e39b0565
Odurny, Allan
83751e10-10f8-4812-bc88-e28d71fb08fb
Stedman, Brian
180a4644-f670-4da1-84db-9d5640e4ec1d
Johnson, Colin D.
e50aa9cd-8c61-4fe3-a0b3-f51cc3a6c74a
May 2011
Whistance, Robert N.
3653139e-e6f4-437e-a299-ec01698a8fab
Shah, Vallari
90cbb755-87d0-454f-891b-13b4ed9d0d29
Grist, Emily R.
9a512ed8-6349-400f-b9d4-80b17fb0ca55
Shearman, Clifford P
cf4d6317-f54d-4ab3-ba49-c6797897bbcf
Pearce, Neil W.
6e450393-03db-472b-9231-1aa2e39b0565
Odurny, Allan
83751e10-10f8-4812-bc88-e28d71fb08fb
Stedman, Brian
180a4644-f670-4da1-84db-9d5640e4ec1d
Johnson, Colin D.
e50aa9cd-8c61-4fe3-a0b3-f51cc3a6c74a
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), .
(doi:10.1308/003588411X13008915740787).
(PMID:21944786)
Abstract
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.
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Published date: May 2011
Organisations:
Cancer Sciences
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Local EPrints ID: 202963
URI: http://eprints.soton.ac.uk/id/eprint/202963
ISSN: 0035-8843
PURE UUID: d03adc2e-bf05-48e1-851c-ce6965dc69cc
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Date deposited: 10 Nov 2011 11:57
Last modified: 14 Mar 2024 04:26
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Author:
Robert N. Whistance
Author:
Vallari Shah
Author:
Emily R. Grist
Author:
Neil W. Pearce
Author:
Allan Odurny
Author:
Brian Stedman
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