TY - JOUR

T1 - Spontaneous intestinal bleeding due to pseudoaneurism of the gastroduodenal artery

T2 - case report of a rare complication to median arcuate ligament syndrome

AU - Jensen, Kristian K

AU - Bonde, Peter

AU - Storkholm, Jan H

AU - Heerwagen, Søren T

AU - Larsen, Peter N

AU - Eiberg, Jonas

N1 - Published by Oxford University Press and JSCR Publishing Ltd. © The Author(s) 2020.

PY - 2020

Y1 - 2020

N2 - Median arcuate ligament syndrome (MALS) is the compression of the celiac artery (CA) by the median arcuate ligament. MALS can cause pseudoaneurysm of the gastroduodenal artery, which can lead to fatal bleeding. A 40-year-old male with no prior medical history presented with symptoms of upper gastrointestinal hemorrhage (UGIH). Severe duodenal bleeding was confirmed although endoscopic hemostasis was impossible and final hemostasis was achieved following a subsequent open duodenotomy. A postoperative computed tomographic angiography (CTA) visualized a significant CA stenosis, post-stenotic dilatation and an aneurysm on a jejunal branch artery. The patient underwent coiling of the gastroduodenal artery, gastroepiploic artery and two pancreaticoduodenal arterial branches. The patient was diagnosed with MALS and 6 months later underwent open resection of the median arcuate ligament. MALS should be considered as a rare cause of upper gastrointestinal bleeding. The literature and proposed treatments are discussed.

AB - Median arcuate ligament syndrome (MALS) is the compression of the celiac artery (CA) by the median arcuate ligament. MALS can cause pseudoaneurysm of the gastroduodenal artery, which can lead to fatal bleeding. A 40-year-old male with no prior medical history presented with symptoms of upper gastrointestinal hemorrhage (UGIH). Severe duodenal bleeding was confirmed although endoscopic hemostasis was impossible and final hemostasis was achieved following a subsequent open duodenotomy. A postoperative computed tomographic angiography (CTA) visualized a significant CA stenosis, post-stenotic dilatation and an aneurysm on a jejunal branch artery. The patient underwent coiling of the gastroduodenal artery, gastroepiploic artery and two pancreaticoduodenal arterial branches. The patient was diagnosed with MALS and 6 months later underwent open resection of the median arcuate ligament. MALS should be considered as a rare cause of upper gastrointestinal bleeding. The literature and proposed treatments are discussed.

U2 - 10.1093/jscr/rjaa507

DO - 10.1093/jscr/rjaa507

M3 - Journal article

C2 - 33365121

VL - 2020

JO - Journal of Surgical Case Reports

JF - Journal of Surgical Case Reports

SN - 2042-8812

IS - 12

M1 - rjaa507

ER -