A case of median arcuate ligament syndrome managed by laparoscopic surgery : The utility of intraoperative ICG fluorography and perioperative 4D flow MRI Yoshifumi MORITA 1 , Takanori SAKAGUCHI 1 , Makoto TAKEDA 1 , Hirotoshi KIKUCHI 1 , Yoshihiro HIRAMATSU 1,2 , Hiroya TAKEUCHI 1 1Department of Surgery, Hamamatsu University School of Medicine 2Department of Perioperative Functioning Care and Support, Hamamatsu University School of Medicine Keyword: 腹腔鏡下正中弓状靱帯切離 , 術中ICG蛍光造影 , 4D flow MRI pp.266-272
Published Date 2019/5/15
DOI https://doi.org/10.11477/mf.4426200705
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 A 44 year-old male visited the affiliated hospital because of sudden epigastralgia. Abdominal enhanced CT showed a large hematoma around the uncinate process of the pancreas and celiac compression by median arcuate ligament (MAL). Since angiography revealed the posterior superior pancreaticoduodenal artery (PSPDA) dissociation, he underwent coil embolization. Since the regurgitated common hepatic artery flow sustained after embolization, he was introduced to our hospital for the purpose of MAL section. Under laparoscopic surgery with 5 ports, the omental cavity was opened and MAL was identified after skeletonization of the diaphragmatic crura and the left gastric artery. These compressing fibers were divided until the aortoceliac artery bifurcation was clearly visualized. After the hemi-circumference of the root of the celiac artery had been dissected, the ligament compression was released. Intraoperative ICG fluorography showed anterograde blood flow from the root of the celiac artery. Postoperative course was uneventful. Perioperative hemodynamic evaluation using 4D flow MRI elucidated the normalization of blood flow from the celiac artery to the common hepatic artery. Laparoscopic MAL section was safely performed and was a good option for patients with MALS.

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