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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).

Record type: Article


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


Local EPrints ID: 202963
ISSN: 0035-8843
PURE UUID: d03adc2e-bf05-48e1-851c-ce6965dc69cc

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Date deposited: 10 Nov 2011 11:57
Last modified: 18 Jul 2017 11:09

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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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