Problems with the Median Arcuate Ligament Should Be Recognized before Surgery; Its Importance in Pancreaticoduodenectomy

Abstract

Background: Celiac artery stenosis (CAS) is a not arare finding in the general population. The median arcuate ligament (MAL) is a fibrous arch that unites thediaphragmatic crura on either side of the aortic hiatusand, while it normally passes cranial to the origin ofthe celiac truncus, a low-lying ligament may lead tocompression of the celiac artery and is the one of themajor causes of CAS.Case Report: In this paper, we present a patient witha mass in the gastric bulbus who was diagnosed withceliac artery stenosis during the pancreaticoduodenec- tomy (PD). MAL was the cause of the celiac artery ste- nosis, determined based on the findings of preoperativecomputed tomography (CT). Conclusion: Although CAS is usually asymptomaticdue to the collateral blood supply, it may be associatedwith potentially disastrous results due to ischemia ofthe upper abdominal organs as a result of disruptionof the collateral pathways. It is especially important torecognize the presence of CAS and its etiology beforeinterventional procedures. With the increasing use ofmultidetector computed tomography (MDCT), it be- comes essential for radiologists to be aware of this entity and the cross-sectional findings.