Case Report
Copyright ©The Author(s) 2022. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Clin Cases. Jul 26, 2022; 10(21): 7509-7516
Published online Jul 26, 2022. doi: 10.12998/wjcc.v10.i21.7509
Median arcuate ligament syndrome with retroperitoneal haemorrhage: A case report
Xiao-Chen Lu, Jian-Guo Pei, Guang-Hua Xie, Yong-Yu Li, Hong-Mei Han
Xiao-Chen Lu, Yong-Yu Li, Hong-Mei Han, Department of Gastroenterology, Affiliated Hospital of Yanbian University, Yanji 133000, Jilin Province, China
Jian-Guo Pei, Department of Imaging, Affiliated Hospital of Yanbian University, Yanji 133000, Jilin Province, China
Guang-Hua Xie, Department of Hepatobiliary Surgery, Affiliated Hospital of Yanbian University, Yanji 133000, Jilin Province, China
Author contributions: Lu XC and Han HM were the main contributors; Lu XC wrote the manuscript; Han HM was the treating physician and was responsible for revising the manuscript; Li YY provided assistance during the diagnosis and treatment; Xie GH performed the surgery; Pei JG helped analyse the imaging data; all authors read and endorsed the final draft.
Informed consent statement: Informed written consent was obtained from the patient for publication of this report and any accompanying images.
Conflict-of-interest statement: The authors declare that they have no conflict of interest to disclose.
CARE Checklist (2016) statement: The authors have read the CARE Checklist (2016), and the manuscript was prepared and revised according to the CARE Checklist (2016).
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Hong-Mei Han, PhD, Doctor, Department of Gastroenterology, Affiliated Hospital of Yanbian University, No. 1327 Yuanzi Street, Yanji 133000, Jilin Province, China. hhml1234@sina.com
Received: December 19, 2021
Peer-review started: December 19, 2021
First decision: February 21, 2022
Revised: February 27, 2022
Accepted: June 13, 2022
Article in press: June 13, 2022
Published online: July 26, 2022
Processing time: 204 Days and 0.4 Hours
Abstract
BACKGROUND

Median arcuate ligament syndrome (MALS) is relatively rare and is due to extraluminal compression of the coeliac artery by the median arcuate ligament of the diaphragm. Here, we report a case of MALS found in a patient with abdominal pain and retroperitoneal haemorrhage for education and dissemination.

CASE SUMMARY

This article describes a 46-year-old female patient who was admitted to our hospital with abdominal pain as her chief complaint. She had experienced no obvious symptoms but had retroperitoneal bleeding during the course of the disease. Contrast-enhanced computed tomography (CT) and noninvasive CT angiography (CTA) led to an initial misdiagnosis of pancreaticoduodenal artery aneurysm (PDAA) causing retroperitoneal hemorrhage. After intraoperative exploration and detailed analysis of enhanced CT and CTA images, a final diagnosis of MALS was made. The cause of the haemorrhage was bleeding from a branch of the gastroduodenal artery, not rupture of a PDAA. The prognosis of MALS combined with PDAA treated by laparoscopy and interventional therapy is still acceptable. The patient was temporarily treated by gastroduodenal suture haemostasis and was referred for further treatment.

CONCLUSION

MALS is very rare and usually has postprandial abdominal pain, upper abdominal murmur, and weight loss. It is diagnosed by imaging or due to complications. When a patient has abdominal bleeding or PDAA, we should consider whether the patient has celiac trunk stenosis (MALS or other etiology). When abdominal bleeding is combined with an aneurysm, we generally think of aneurysm rupture and hemorrhage first, but it may also be collateral artery rupture and hemorrhage.

Keywords: Median arcuate ligament syndrome; Retroperitoneal haemorrhage; Pancreaticoduodenal artery aneurysm; Case report

Core Tip: Median arcuate ligament syndrome (MALS) is relatively rare and is due to extraluminal compression of the coeliac artery by the median arcuate ligament of the diaphragm. Here, we report a case of MALS found in a patient with abdominal pain and bleeding, for education and dissemination.