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Objective To investigate the effect of ultrasound-guided anterior quadratus lumborum block at lateral supra-arcuate ligament on postoperative analgesia and inflammation response in elderly patients undergoing robot-assisted laparoscopic radical prostatectomy.Methods A total of 60 elderly patients who had undergone robot-assisted laparoscopic radical prostatectomy from June 2022 to June 2023 were randomly divided into a group of ultra-sound-guided anterior quadratus lumborum block at lateral supra-arcuate ligament combined with general anesthesia(observation group,n = 30)and a general anesthesia group(control group,n = 30).Both groups received patient-controlled intravenous analgesia after surgery.The first compression time of an analgesic pump and the numbers of effective compression and remedial analgesia were recorded.The VAS scores at postsurgical hours 2,12,24,and 48 during rest and coughing were recorded.Interleukin-6(IL-6)and systemic immunoinflammatory index(SII)at one day before surgery and two hours,one day and three days after surgery were recorded.Anal exhaust time,length of postoperative hospital stay and occurrence of adverse reactions were recorded.Results The observation group,as compared with the control group,had significantly longer first compression time of an analgesic pump and had fewer numbers of effective compressions and remedial analgesic administrations(P<0.05).The VAS scores during rest and coughing in the observation group were lower than those in the control group at postsurgical hours 2,12,24,and 48(P<0.05).As compared with one day before surgery,both IL-6 and SII in the two groups increased at 2 hours,1,and 3 days after surgery,but the changes in the observation group were lower than those in the control group(P<0.05).As compared with the control group,the observation group had shorter anal exhaust time and length of postoperative hospital stay,and a lower incidence of adverse reactions(P<0.05).Conclusions Ultrasound-guided anterior quadratus lumborum block at lateral supra-arcuate ligament can provide better postoperative analgesia,reduce inflammatory response and accelerate postoperative recovery in elderly patients undergoing robot-assisted laparoscopic radical prostatectomy.
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Objective To observe the effect of ultrasound-guided anterior quadratus lumborum block at lateral supra-arcuate ligament(QLB-LSAL)and transversus abdominis plane block(TAPB)on analgesia and recovery quality after laparoscopic partial hepatectomy(LPH).Methods Fifty-eight patients underwent elective LPH were selected and divided into the quadratus lumborum group or the transversus abdominis group randomly,with 29 patients in each group.The quadratus lumborum group received bilateral QLB-LSAL,and the transversus abdominis group received bilateral subcostal TAPB block before surgery.Both groups received 20 mL of 0.33%ropivacaine on each side.All patients used patient-controlled intravenous analgesia(PCIA)postoperatively.The numeric rating scale(NRS)scores for rest and movement were recorded at 2,4,6,12,24 and 48 hours postoperatively,as well as the Quality of Recovery-15(QoR-15)scores at 1 day preoperatively,1 and 3 days postoperatively.The perioperative anesthetic agent consumption,PCIA pressing frequency,remedial analgesia use in 48 h,postoperative nausea and vomiting(PONV)incidence and time of first out-of-bed mobilization were also recorded.Results Compared with the transversus abdominis group,the quadratus lumborum group had lower movement NRS scores at 2,4,6,12,24 and 48 hours postoperatively,and lower rest NRS scores at 2,4,6,12 and 24 hours postoperatively(P＜0.05).The quadratus lumborum group had higher QoR-15 scores at 1 and 3 days postoperatively(P＜0.05).Patients in the quadratus lumborum group had reduced perioperative remifentanil and sufentanil consumption,postoperative 48-hour rescue analgesia use,PCIA pressing frequency,PONV incidence and time of first out-of-bed mobilization(P＜0.05).Conclusion QLB-LSAL block provides superior analgesic effects and recovery quality compared to TAPB block after LPH.
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Objective:To investigate the analgesic effect of ultrasound-guided quadratus lumborum block at the lateral supra arcuate ligament (LSQLB) and subcostal transversus abdominis plane block (TAPB) for open liver surgery.Methods:Forty-two patients who underwent elective open liver surgery in Lishui Central Hospital from February 2021 to October 2021 were randomly divided into two groups: LSQLB group (L group, n=21) and TAPB group (T group, n=21). Both groups underwent preoperative ultrasound-guided nerve block, and then LSQLB in group L and subcostal TAPB under the right costal margin in group T. The surgery was subsequently completed under general anesthesia. Patient controlled intravenous analgesia (PCIA) was performed in both groups. The mean arterial pressure (MAP) and heart rate (HR) before skin cutting (T 0), immediately after skin cutting (T 1), at the time of liver exploration (T 2), and at the time of suturing (T 3) were compared between the two groups; the intraoperative sufentanil and remifentanil consumption was recorded; the visual analogue score (VAS) of pain at 2, 8, 16, 24, and 48 h postoperatively and the number of analgesic pump presses and remedial analgesia at 48 h postoperatively were recorded. The incidence of adverse effects such as postoperative hypotonia (lower limb muscle strength ≤grade 4 on the blocked side), hypotension, nausea and vomiting were recorded. Results:The MAP and HR at T 1, T 2 and T 3, the dosage of sufentanil and remifentanil during operation of group L were lower than those of group T(all P<0.05); the VAS score at 2, 8, 16 and 24 hours after operation in group L were lower than those of group T (all P<0.05). The number of analgesic pump presses and remedial analgesia at 48 hours postoperatively in group L were less than those in group T after operation (all P<0.05). There was no statistically significant difference in the incidence of adverse reactions such as postoperative hypokinesia, hypotension, nausea and vomiting in the two groups (all P>0.05). Conclusions:LSQLB for open liver surgery is more hemodynamically stable and has a more definite analgesic effect.
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Objective:To evaluate the optimization efficacy of anterior quadratus lumborum block at supra-arcuate ligament (SA-AQLB) combined with general anesthesia for laparoscopic gynecological surgery.Methods:Eighty American Society of Anesthesiologists physical status Ⅰ or Ⅱ patients, aged 28-64 yr, weighing 52-78 kg, with height of 154-166 cm, scheduled for elective laparoscopic gynecological surgery, were divided into general anesthesia group (group G, n=40) and SA-AQLB combined with general anesthesia group (group SG, n=40) using a random number table method.In group SG, bilateral SA-AQLB was performed under ultrasound guidance before anesthesia induction, and 0.4% ropivacaine 25 ml plus dexamethasone 5 mg was injected into both sides.Combined intravenous-inhalational anesthesia was applied in both groups.Patient-controlled intravenous analgesia (PCIA) with sufentanil 2 μg/kg (in 150 ml of normal saline) was performed after surgery.The PCIA pump was set up to deliver a 2 ml bolus dose with a 15-min lockout interval and background infusion at 2 ml/h.Visual analogue scale (VAS) scores for abdomen, pelvis and shoulder pain were recorded at 1, 6, 12, 24 and 48 h after operation.Flurbiprofen was used for rescue analgesia when VAS score >4.The occurrence of intraoperative cardiovascular events and amount of sufentanil used during operation were recorded.The time to first pressing the analgesia pump, effective pressing times of PCA, requirement for rescue analgesia and consumption of sufentanil after operation were recorded.The extubation time, time to first flatus after operation, first ambulation time, length of hospital stay and development of postoperative adverse reactions such as nausea and vomiting, urinary retention and respiratory depression within 48 h after operation were recorded. Results:Compared with group G, the incidence of intraoperative hypertension and tachycardia was significantly decreased, the incidence of intraoperative hypotension and bradycardia was increased, the intraoperative consumption of sufentanil was reduced, the extubation time was shortened, the time to first pressing the analgesia pump was prolonged, the effective pressing times of PCA, requirement for rescue analgesia and postoperative consumption of sufentanil were reduced, the time to first flatus, first ambulation time and length of hospital stay were shortened, VAS scores for abdomen, pelvis and shoulder pain were decreased at each time point after operation, and the incidence of nausea and vomiting, urinary retention and respiratory depression after operation was decreased in group SG ( P<0.01). Conclusions:Compared with general anesthesia, the combination of SA-AQLB and general anesthesia can reduce the opioid consumption, inhibit intraoperative stress responses and postoperative hyperalgesia and promote early postoperative recovery when used for the patients undergoing laparoscopic gynecological surgery.
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Objective:To investigate the features of median arcuate ligament syndrome (MALS) in computed tomography angiography (CTA).Methods:The retrospective and descriptive study was conducted. The clinical and imaging data of 56 patients with MALS who were admitted to Ruijin Hospital, Shanghai JiaoTong University School of Medicine from November 2019 to October 2020 were collected. There were 30 males and 26 females, aged from 19 to 78 years, with a median age of 54 years. All 56 patients underwent CTA. Observation indicators: (1) CTA examination; (2) correlation analysis; (3) surgical situations. Measurement data with normal distribution were represented as Mean± SD. Count data were described as absolute numbers or percentages. Spearman correlation analysis with test level of 0.05 was used to analyze the correlation between celiac trunk stenosis and the distance between the original location of celiac trunk and original location of superior mesenteric artery and the minimum distance of celiac trunk and superior mesenteric artery. Results:(1) CTA examination. ① Celiac trunk stenosis: results of cross sectional examina-tion of CTA showed that of 56 patients, there were 2 cases of celiac trunk occlusion, 10 cases of severe stenosis, 9 cases of moderate stenosis and 35 cases of mild stenosis. Results of sagittal examination of CTA showed that of 56 patients, there were 2 cases of celiac trunk occlusion, 21 cases of severe stenosis, 15 cases of moderate stenosis and 18 cases of mild stenosis. ② Examination of patients with different degree of vascular stenosis: according to the results of sagittal examination of CTA, the 2 cases with celiac trunk occlusion were negative for aneurysms, aortic dissection or vascular variations but positive for compensated varix of the anterior and posterior pancreatico-duodenal arches. Of the 21 cases with celiac trunk severe stenosis, 2 cases were positive for aneurysms, 1 case was positive for aortic dissection, 7 cases were positive for compensated varix of the anterior and posterior pancreaticoduodenal arches, 8 cases were positive for collateral circula-tions of anterior and posterior pancreaticoduodenal archs and 8 cases were positive for vascular variation. Of the 15 cases with celiac trunk moderate stenosis, 2 cases were positive for aneurysms, 3 cases were positive for aortic dissection, 2 cases were positive for compensated varix of the anterior and posterior pancreaticoduodenal arches, 4 cases were positive for collateral circulations of anterior and posterior pancreaticoduodenal archs and 7 cases were positive for vascular variation. Of the 18 cases with celiac trunk mild stenosis, 1 case was positive for aneurysms, 2 cases were positive for aortic dissection, 7 cases were positive for collateral circulations of the anterior and posterior pancreaticoduodenal arches, 6 cases were positive for vascular variation. All 56 patients were negative for ischemia of liver, spleen and stomach. ③ Original location of celiac trunk: of 56 patients, there were 43 cases had celiac trunk originated horizontally from the lower edge of T12 vertebral body, 2 cases had celiac trunk originated from the middle of T12 vertebral body, 1 case had celiac trunk originated from the upper part of T12 vertebral body, 7 cases had celiac trunk originated from the upper part of L1 vertebral body, 1 case had celiac trunk originated from the middle of L1 vertebral body and 2 cases had occluding celiac trunk. (2) Correlation analysis: results of sagittal observation on CTA examination showed the distance between the original location of celiac trunk and original location of superior mesenteric artery of the 56 patients was (6.0±4.0) mm. The distance between the original location of celiac trunk and original location of superior mesenteric artery of patients with celiac trunk mild, moderate or severe stenosis were (6.2±2.8)mm, (8.1±4.4)mm and (5.3±3.2)mm respectively. There were 23 cases of the 56 patients had the distance between the original location of celiac trunk and original location of superior mesenteric artery <5 mm. Results of correlation analysis showed that the degree of celiac trunk stenosis was not related to the distance between the original location of celiac trunk and original location of superior mesenteric artery ( r=?0.205, P>0.05). Results of sagittal observation on CTA examination showed the shortest distance between celiac trunk and superior mesenteric artery of the 56 patients was (3.8±2.4)mm. The shortest distance between celiac trunk and superior mesenteric artery of patients with celiac trunk mild, moderate or severe stenosis were (4.2±2.0)mm, (4.4±3.3)mm and (3.0±1.9)mm, respectively. There were 45 cases of the 56 patients had the shortest distance between celiac trunk and superior mesenteric artery <5 mm. Results of correlation analysis showed that the degree of celiac trunk stenosis was not related to the shortest distance between celiac trunk and superior mesenteric artery ( r=?0.249, P>0.05). (3) Surgical situations: of 56 patients, 2 cases were positive for clinical symptoms of abdominal pain, 54 cases were negative for clinical symptoms, 4 cases under-went surgical treatment and 52 cases not underwent surgical treatment. Of the 4 cases undergoing surgical treatment, 2 cases with abdominal pain were diagnosed as MALS by upper abdominal CTA. Celiac trunk of the 2 cases were severe stenosis and stents implantation under celiac arteriography were performed. Results of postoperative CTA showed celiac trunk was negative for obvious stenosis. The other 2 cases who were negative for clinical symptoms of MALS were planed to pancreaticoduo-denectomy for pancreatic head tumor. Results of preoperative CTA showed severe stenosis of celiac trunk and arterial bypass grafting was performed for the 2 cases during pancreaticoduodenectomy to alleviate liver ischemia caused by gastroduodenal artery ligation which would avoid the incidence of postoperative MALS associated complications. Result of postoperative CTA three-dimensional reconstruction showed the bypass vessel was unobstructed. Conclusion:Based on sagittal result of CTA examination, the stenosis of celiac trunk, the anatomical relationship between celiac trunk and arcuate ligament and the original location of celiac trunk of MALS patients can be evaluated.
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Median arcuate ligament syndrome(MALS)is compression of the celiac trunk by the median arcuate ligament.Median arcuate ligament release is the corner stone for the surgical treatment of MALS.Open surgery,laparoscopic surgery,and robot-assisted surgery have been developed,among which laparoscopic surgery has been proposed as the preferred approach in view of its minimal trauma and short hospital stay.Auxiliary celiac plexus neurolysis could further alleviate the patient's discomfort.Moreover,vascular reconstitution is of vital importance in the case of persistent stenosis in the celiac artery despite of median arcuate ligament decompression.Vascular reconstruction has satisfactory long-term patency rate,while endovascular treatment is less invasive.This article aims to summarize the consensuses and advances and shed light on the surgical treatment of MALS.
Subject(s)
Humans , Celiac Artery/surgery , Constriction, Pathologic/surgery , Decompression, Surgical , Laparoscopy , Ligaments/surgery , Median Arcuate Ligament Syndrome/surgeryABSTRACT
Median arcuate ligament syndrome is an uncommon cause for abdominal pain and weight loss, caused by median arcuate ligament compressing the celiac plexus or artery. Median arcuate ligament is the continuation of the posterior diaphragm which passes superior to celiac artery and surrounds the aorta. In this case report, A 67 year old male presented with complaints of sudden onset chest pain and loss of weight for the past 6 months. CECT thorax and abdomen it showed features of focal stenosis of coeliac axis and post stenotic dilation of the coeliac trunk suggesting median arcuate ligament syndrome. Laparoscopic median arcuate ligament release was done to relieve the patient from symptoms. Diagnosis of median arcuate ligament syndrome should be considered in a patient presenting with chest pain and weight loss with normal cardiac status and unexplained etiology.
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ABSTRACT Background: Median arcuate ligament syndrome(MALS) is a rare condition thatmay cause significant clinical manifestations, including abdominal pain and weight loss. Its diagnosis may be difficult and very often delayed. The laparoscopic approach became the standard treatment of MALS. Aim: To assess the outcome of laparoscopic treatment in patients with MALS. Method: The data of sixpatients with MALS who were subjected to laparoscopic sectioning of the median arcuate ligament were retrospectively reviewed.The following data were evaluated: age, gender, clinical and diagnostic tests findings, ASA score, operative findings and complications, postoperative complications and mortality, hospital stay duration, and hospital readmission.The diagnosis of MALS was established by CT angiography and/or MR angiography. Results: There were four (66.7%) women and two (33.3%) men aged from 32 to 60 years. The main symptoms were epigastric pain (100%) and weight loss (66.7%). The findings of high-grade stenosis of the proximal celiac axis and poststenotic dilation confirmed on angiography confirmed the diagnosis in all patients. Surgical procedure was uneventful in all patients. The only postoperative complication was urinary retention that occurred in a male. At three-month follow-up, all patients were asymptomatic. Conclusion: Laparoscopic treatment of MALS is safe and effective in relieving the clinical manifestations of patients.
RESUMO Racional: A síndrome do ligamento arqueado mediano (SLAM) é condição rara que pode causar manifestações clínicas significativas, incluindo dor abdominal e perda de peso. Seu diagnóstico pode ser difícil e muitas vezes estabelecido tardiamente. A abordagem laparoscópica tornou-se o tratamento padrão para ela. Objetivo: Avaliar o resultado do tratamento laparoscópico em pacientes com SLAM. Método: Os dados de seis pacientes com SLAM submetidos a ressecção laparoscópica do ligamento arqueado mediano foram revisados retrospectivamente. Os seguintes dados avaliados foram: idade, gênero, resultados dosexames clínicos e complementares, escore ASA, achados e complicações operatórias, complicações e mortalidade pós-operatórias, tempo de internação e readmissão hospitalar. O diagnóstico de SLAM foi estabelecido por angiotomografia e/ou angiorressonância. Resultados: Havia quatro (66,7%) mulheres e dois (33,3%) homens com idades entre 32 e 60 anos. Os principais sintomas foram dor epigástrica (100%) e perda de peso (66,7%). Os achados de estenose de alto grau do tronco celíaco proximal e dilatação pós-estenótica observados na angiografia confirmaram o diagnóstico em todos os pacientes. O procedimento cirúrgico transcorreu sem intercorrências em todos os pacientes. A única complicação pós-operatória foi retenção urinária, que ocorreu em um homem. No seguimento de três meses, todos os pacientes estavam assintomáticos. Conclusão: O tratamento laparoscópico da SLAM é seguro e eficaz no alívio das manifestações clínicas dos pacientes.
Subject(s)
Humans , Male , Female , Adult , Middle Aged , Laparoscopy/methods , Median Arcuate Ligament Syndrome/surgery , Prospective Studies , Follow-Up Studies , Treatment OutcomeABSTRACT
Celiac artery compression syndrome, also referred to as median arcuate ligament syndrome, celiac axis syndrome or Dunbar syndrome is a rare disorder consequent to extrinsic compression of the celiac trunk by the median arcuate ligament. Doppler ultrasound, multi-slice computed tomography angiography, magnetic resonance angiography, or invasive selective angiography can identify stenosis of the initial segment of the celiac artery and confirm diagnosis. Treatment options include open surgical or videolaparoscopic section of the median arcuate ligament and the fibers of the celiac plexus, or percutaneous transluminal angioplasty via an endovascular approach. We report herein an interesting case of a 38-year-old woman diagnosed with this rare condition and successfully treated with the surgical strategy
A síndrome da compressão da artéria celíaca, também denominada síndrome do ligamento arqueado mediano, síndrome do eixo celíaco ou síndrome de Dunbar, é uma doença rara causada pela compressão extrínseca do tronco celíaco pelo ligamento arqueado mediano. Ultrassonografia Doppler, angiotomografia computadorizada, angiorressonância magnética ou angiografia seletiva invasiva conseguem identificar a estenose do segmento inicial da artéria celíaca e confirmar o diagnóstico. As opções de tratamento incluem secção videolaparoscópica ou laparotômica (a céu aberto) do ligamento arqueado mediano e das fibras do plexo celíaco, assim como angioplastia transluminal percutânea. Relatamos o interessante caso de uma mulher de 38 anos de idade diagnosticada com essa rara condição e adequadamente tratada pela estratégia cirúrgica
Subject(s)
Humans , Female , Adult , Celiac Artery , Median Arcuate Ligament Syndrome , Angiography/methods , Magnetic Resonance Spectroscopy/methods , Angioplasty/methods , Laparoscopy/methods , Ultrasonography, Doppler/methods , Constriction, PathologicABSTRACT
The median arcuate ligament (MAL) syndrome is an infrequently described condition caused by compression of the celiac artery by the extended fibers of the MAL resulting in the classic triad of postprandial epigastric pain, nausea/vomiting, and weight loss. Mostly seen in young female adults there is no reported estimate in the pediatric age group. We report the case in a 15-year-old girl and discuss the surgical aspects of importance.
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We describe 2 cases of patients with loss of hepatic arterial flow during surgery for pancreatic head cancer due to celiac stenosis caused by median arcuate ligament compression. The first case underwent pylorus-resecting pancreatoduodenectomy for pancreatic head cancer. After resection of the gastroduodenal artery, flow in the common hepatic artery disappeared, and celiac axis stenosis was identified. Interventional stent insertion was attempted, however, it failed due to the acute angle of the celiac orifice (os). This problem was resolved by arterial reconstruction. The second case underwent pylorus-preserving pancreatoduodenectomy for pancreatic head cancer and the same phenomenon occurred during the procedure. Interventional stent insertion was also tried; in this patient, however, it failed due to the acute angle of the celiac os. The problem was resolved by changing a femoral approach to a brachial approach, and the stent was inserted into the celiac os successfully.
Subject(s)
Humans , Arteries , Constriction, Pathologic , Head and Neck Neoplasms , Hepatic Artery , Ligaments , Pancreaticoduodenectomy , StentsABSTRACT
We describe 2 cases of patients with loss of hepatic arterial flow during surgery for pancreatic head cancer due to celiac stenosis caused by median arcuate ligament compression. The first case underwent pylorus-resecting pancreatoduodenectomy for pancreatic head cancer. After resection of the gastroduodenal artery, flow in the common hepatic artery disappeared, and celiac axis stenosis was identified. Interventional stent insertion was attempted, however, it failed due to the acute angle of the celiac orifice (os). This problem was resolved by arterial reconstruction. The second case underwent pylorus-preserving pancreatoduodenectomy for pancreatic head cancer and the same phenomenon occurred during the procedure. Interventional stent insertion was also tried; in this patient, however, it failed due to the acute angle of the celiac os. The problem was resolved by changing a femoral approach to a brachial approach, and the stent was inserted into the celiac os successfully.
Subject(s)
Humans , Arteries , Constriction, Pathologic , Head and Neck Neoplasms , Hepatic Artery , Ligaments , Pancreaticoduodenectomy , StentsABSTRACT
Purpose Median arcuate ligament (MAL) compression is the most common reason for celiac artery stenosis or occlusion, celiac artery compression of asymptomatic MAL is often misdiagnosed. This study aims to evaluate the multi-slice spiral CT manifestations of the celiac artery compression of median arcuate ligament. Materials and Methods CT features of 26 patients with celiac artery compression of median arcuate ligament were retrospectively studied. Eleven cases were symptomatic and fifteen cases were asymptomatic. Results In 14 cases (53.8%), the location of compression was at the level of superior 1/3 of the L1 vertebral body. There was statistic difference in location of the origin of compression between the celiac artery narrowing group and the non-narrowing group (P<0.05). CT manifestations included: narrowing of the celiac artery were observed in 26 patients on sagittal reformatted images with hollow on the anterior wall; a characteristic hooked appearance was observed. Narrowed celiac artery on the transverse images was seen in 21 patients, and a soft-tissue band extending across the anterior aspect of artery in 12 of them. Poststenotic dilatation was revealed in 20 patients. Collateral circulation was seen in 8 patients. Conclusion Multi-slice spiral CT can be helpful in demonstrating the location of celiac artery compression of median arcuate ligament and tell the characteristic imaging features.
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El síndrome del ligamento arcuato medio (SLAM), o síndrome de compresión del tronco celíaco, es causado por la compresión extrínseca del ligamento arcuato medio, bandas fibrosas prominentes y tejido ganglionar periaórtico. En muchas ocasiones es asintomático, pero puede manifestarse con síntomas como dolor abdominal postprandial o durante el ejercicio, náuseas, vómitos y pérdida de peso. Mediante técnicas poco invasivas, como la ecografía doppler color y la angiotomografía preoperatoria, es posible obtener resultados diagnósticos comparables a los de la arteriografía. La cirugía constituye el tratamiento de elección, siendo la vía laparoscópica una técnica segura y eficaz Se presenta un caso sintomático atípico que requirió tratamiento quirúrgico laparoscópico, con mejoría clínica e imagenológica luego del procedimiento.
Median arcuate ligament syndrome (MALS), or celiac trunk compression syndrome, is caused by extrinsic compression of median arcuate ligament, prominent fibrous bands and periaortic nodal tissue. In many cases is asymptomatic, but it may manifests with symptoms such as postprandial abdominal pain or during exercise, nauseas, vomiting and weight loss. Trough less invasive diagnostic techniques, such as doppler ultrasound for screening and preoperative angiotomograhpy, it is possible to obtain good results, comparable to those with arteriography. Surgical treatment by laparoscopic approach is a safe and effective technique. A symptomatic case that required surgical treatment, a laparoscopic approach, with clinical and imaging improvement after the procedure, is presented.
Subject(s)
Aged , Female , Humans , Celiac Artery/abnormalities , Constriction, Pathologic/diagnosis , Celiac Artery/surgery , Constriction, Pathologic/surgery , LaparoscopyABSTRACT
Background: Median arcuate ligament syndrome (SLAM) is caused by extrinsic compression of the celiac artery by fibrous bands of this ligament and periaortic lymph node tissue. Case report: We report a 59 years old man with a history of weight loss, epigastric pain and a postprandial murmur. The syndrome was diagnosed by CT angiography. The patient was operated, performing a midline laparotomy and releasing the extrinsic compression. An early and sustained remission of symptoms was achieved.
Introducción: El síndrome del ligamento arcuato medio (SLAM), es causado por la compresión extrínseca del tronco celíaco por bandas fibrosas de este ligamento y tejido ganglionar periaórtico. Caso clínico: Reportamos el caso de un hombre de 59 años con historia de baja de peso, dolor postprandial y soplo epigástrico, al cual se le diagnostica SLAM por medio de angioTC. Se realiza abordaje quirúrgico, con laparotomía media y liberación de la compresión extrínseca, logrando remisión de los síntomas de forma inmediata y sostenida. El SLAM es una causa infrecuente de dolor abdominal, requiere estudio por imágenes para su diagnóstico, la resolución quirúrgica constituye su tratamiento.
Subject(s)
Humans , Male , Middle Aged , Celiac Artery/surgery , Celiac Artery/pathology , Constriction, Pathologic/surgery , Constriction, Pathologic/etiology , Ligaments/surgery , Ligaments/pathology , Angiography , Tomography, X-Ray ComputedABSTRACT
Median arcuate ligament syndrome is an anatomic and clinical entity characterized by dynamic compression of the proximal celiac artery by the median arcuate ligament, which leads to postprandial epigastric pain, vomiting, and weight loss. These symptoms are usually nonspecific and are easily misdiagnosed as functional dyspepsia, peptic ulcer disease, or gastropathy. In this report, we presented a 72-year-old male patient with celiac artery compression syndrome causing recurrent abdominal pain associated with gastric ulcer and iron deficiency anemia. This association is relatively uncommon and therefore not well determined. In addition, we reported the CT angiography findings and three-dimensional reconstructions of this rare case.
Subject(s)
Aged , Humans , Male , Abdominal Pain/etiology , Anemia, Iron-Deficiency/etiology , Angiography/methods , Arterial Occlusive Diseases/diagnostic imaging , Celiac Artery/abnormalities , Constriction, Pathologic/complications , Diaphragm , Recurrence , Stomach Ulcer/complications , Syndrome , Tomography, X-Ray Computed , Weight LossABSTRACT
Median arcuate ligament syndrome is a rare cause of abdominal pain which results from compression of the celiac artery (CA) or rarely, the superior mesenteric artery by a ligament formed by the right and left crura of the diaphragm. We report a case of open surgical decompression of the CA by division of the median arcuate ligament for a 37-year-old female patient who had suffered from chronic postprandial epigastric pain and severe weight loss. We described clinical features, characteristic angiographic findings and details of the surgical procedure for the patient with this rare vascular problem.
Subject(s)
Female , Humans , Abdominal Pain , Axis, Cervical Vertebra , Celiac Artery , Decompression, Surgical , Diaphragm , Ligaments , Mesenteric Artery, Superior , Weight LossABSTRACT
Background/Aim Compression of celiac artery by median arcuate ligament (MAL) may cause abdominal symptoms. This study looked at the prevalence of this finding in asymptomatic persons. Methods Abdominal angiograms of 155 healthy asymptomatic voluntary kidney donors aged 18–65 years, done as part of the standard pretransplant work up, were reviewed retrospectively. Results Celiac axis compression, defined as greater than 50% luminal narrowing of the celiac artery by the MAL was found in eight (5.1%) of 155 angiograms. Conclusion The high frequency of this finding reemphasizes the need for caution in attributing abdominal symptoms to such compression based on imaging findings alone.
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[Objective]To discuss the anatomy and etiology of cubital tunnel syndrome.[Method]The clinical data and surgical findings of sixty five cubital tunnel syndrome cases were analyzed,and the per-operative electromyogram results of twenty five cases were studied.[Result]Hypertrophy of arcuate ligament resulted in compression and abrasion of ulnar nerve in sixty patients;we found that the ulnar nerve conduct velocity decreased(the average speed was 27.97 m/s),motional amplitude also decreased(the average voltage was 1.95 mv),and latent period prolonged(the average time was 5.41 ms)after pre-operative electromyogram.[Conclusion]The major etiology of cubital tunnel syndrome is chronic injury with sustained compression of ulnar nerve around elbow joint.Careful physical examination of ulnar nerve function and pre-operative electromyogram will help us to diagnose the cubital tunnel syndrome.Cubital tunnel syndrome should be differentiated from tardy ulnar nerve palsy of other sites.
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PURPOSE: The purpose of our study was to determine the effectiveness of primary repair of arcuate ligament complex in posterolateral rotary instability of knee. MATERIALS AND METHODS: We reviewed the clinical records and operative notes of 9 patients who were treated by primary repair for the acute posterolateral rotary instability and followed more than 1 year. All the 9 knees had a positive external rotation recurvatum test and a positive posterolateral drawer test, One or more components of the arcuate ligament complex were injured in all cases and associated injuries were posterior cruciate ligament rupture in 6, lateral collateral ligament in 5, anterior cruciate ligament partial rupture in 2, biceps femoris rupture in 2, meniscus tear in 3, iliotibial band rupture in 1, ipsilateral femur fracture in 1 and peroneal nerve palsy in 1. RESULTS: By objective rating index, the results were classified as good (4 patients), fair (4 patients) and poor (1 patient). By functionally, the results were classified as good (6 patients), fair (3 patients). CONCLUSIONS: Consequently, we believe that primary repair of arcuate ligament complex in acute stage can result in objectively and functionally acceptable knee function.