1/6. pancreaticoduodenectomy and the celiac artery compression syndrome.Celiac compression is usually a benign condition, but when surgery necessitates division of collaterals from the superior mesenteric artery, it may cause life-threatening gut ischemia. We report a case of cholangiocarcinoma necessitating pancreaticoduodenectomy in a patient with celiac artery compression by the median arcuate ligament. Preoperative duplex scanning confirmed the celiac stenosis and revealed retrograde flow through collaterals from the superior mesenteric artery. Intraoperative continuous wave Doppler examination revealed that gastric blood flow disappeared with compression of the superior mesenteric artery. This maneuver no longer affected gastric flow after transection of the compressing structures at the celiac origin. Preoperative identification of celiac artery stenosis is crucial to prevent small bowel ischemia and possible anastomotic breakdown or liver failure. Duplex scanning can provide important insight about collateral circulation, and intraoperative Doppler testing can assess the adequacy of revascularization.- - - - - - - - - - ranking = 1keywords = ligament (Clic here for more details about this article) |
2/6. Mesenteric venous infarction presenting as an upper GI bleeding and diagnosed by upper GI endoscopy.A case of primary mesenteric vein thrombosis with extensive small bowel infarct beginning at the ligament of Treitz presented as upper gastrointestinal bleeding. Although endoscopy of the upper GI tract disclosed erosive gastritis this finding was considered insufficient to explain the hematemesis; therefore the endoscope was advanced further until a necrotic and aperistaltic-looking mucosa was found in the area of the ligament of Treitz. This paper describes the endoscopic picture of necrotic duodenal mucosa, and stresses the importance of a deeper examination into the duodenum when a clear-cut cause for the bleeding is not found in the stomach or duodenal bulb.- - - - - - - - - - ranking = 2keywords = ligament (Clic here for more details about this article) |
3/6. Median arcuate ligament syndrome with severe two-vessel involvement.Intestinal angina is an unusual condition caused by decreased blood supply to the abdominal viscera. It has been hypothesized that at least two of the three vessels supplying the viscera need to be compromised to cause ischemia. On the other hand, compression of the celiac axis by the medium arcuate ligament, causing symptoms, has been reported. We described a severely symptomatic patient in whom this ligament completely occluded the celiac axis and severely narrowed the superior mesenteric artery. The condition was cured by division of the ligament.- - - - - - - - - - ranking = 7keywords = ligament (Clic here for more details about this article) |
4/6. Median arcuate ligament compression syndrome in monozygotic twins.Twin 27-year-old women had symptomatic mesenteric ischemia caused by median arcuate ligament compression. Arteriography demonstrated severe celiac artery stenosis in one twin, celiac artery occlusion in the other, and proximal superior mesenteric artery narrowing with retrograde filling from a meandering mesenteric artery in both. Division of the ligament and direct celiac artery revascularization completely relieved symptoms in both patients. Median arcuate ligament compression of the celiac and superior mesenteric arteries can result in mesenteric ischemia. documentation of this unusual syndrome in monozygotic twins suggests that the responsible anatomic relationships are congenital.- - - - - - - - - - ranking = 7keywords = ligament (Clic here for more details about this article) |
5/6. Median arcuate ligament syndrome with multivessel involvement: diagnosis with spiral CT angiography.Intestinal angina may be caused by compression of the celiac artery by the median arcuate ligament of the diaphragm. aortography can suggest the diagnosis, but the diaphragm cannot be visualized by this examination. We report a symptomatic woman in whom spiral computed tomography-guided angiography demonstrated stenosis of the celiac artery, superior mesenteric artery, and both renal arteries due to diaphragmatic compression. Surgery was beneficial.- - - - - - - - - - ranking = 5keywords = ligament (Clic here for more details about this article) |
6/6. Intraoperative US diagnosis of pylephlebitis (portal vein thrombosis) as a complication of appendicitis: a case report.We report a case of infectious thrombosis of the superior mesenteric vein (pylephlebitis) that was suspected preoperatively with computed tomography and confirmed at intraoperative ultrasonography as confined to the extrahepatic portal vein and superior mesenteric vein. Intraoperative ultrasonography revealed intraluminal echogenic thrombus material in the dilated superior mesenteric and extrahepatic portal veins, slightly dilated open splenic vein, and numerous venous collaterals in the hepatoduodenal ligament. When preoperative imaging studies are inconclusive, intraoperative sonography can confirm the correct diagnosis of pylephlebitis and may give valuable information about the extent of the thrombosis.- - - - - - - - - - ranking = 1keywords = ligament (Clic here for more details about this article) |