title: Median arcuate ligament syndrome presenting as hemorrhagic shock.
abstract: The major symptoms of median arcuate ligament syndrome, celiac axis stenosis, or occlusion compressed by the median arcuate ligament include eating-associated abdominal pain and weight loss. Because celiac stenosis increases retrograde collateral blood flow from the superior mesenteric artery to the celiac artery via the pancreaticoduodenal arcade, a pancreaticoduodenal artery aneurysm could occur at a low incidence rate. Rupture of the pancreaticoduodenal artery aneurysm and hemorrhagic shock are rare. In this report, we present 3 cases of patients who had been well with no abdominal symptoms until the day of admission, when they experienced sudden-onset intra-abdominal hemorrhage and shock. These 3 patients were admitted to the emergency department, and contrast-enhanced computed tomography and radiographic selective catheter angiography revealed intra-abdominal hemorrhage, stenosis of the celiac arteries, and dilated pancreaticoduodenal arcade. Case 1 demonstrated severe hemorrhagic shock, whereas case 2 demonstrated moderate shock. We treated ruptured pancreaticoduodenal artery aneurysms with coil embolization. Case 3 demonstrated complete celiac occlusion and moderate hemorrhagic shock, and no aneurysm was detected.
authors.affiliation: Department of Emergency and Critical Care Medicine, Chiba University Graduate School of Medicine, Chuo, Chiba, Japan.
authors.forename: Yosuke
authors.initials: Y
authors.lastname: Matsumura
authors.forename: Taka-aki
authors.initials: TA
authors.lastname: Nakada
authors.forename: Yoshiro
authors.initials: Y
authors.lastname: Kobe
authors.forename: Noriyuki
authors.initials: N
authors.lastname: Hattori
authors.forename: Shigeto
authors.initials: S
authors.lastname: Oda
mesh_terms: D000328:Adult; D000368:Aged; D017542:Aneurysm, Ruptured / Q000000981:diagnostic imaging / Q000209:etiology; D002445:Celiac Artery / Q000002:abnormalities / Q000000981:diagnostic imaging; D003251:Constriction, Pathologic / Q000150:complications / Q000000981:diagnostic imaging*; D005260:Female; D006801:Humans; D008297:Male; D000074742:Median Arcuate Ligament Syndrome; D008875:Middle Aged; D012771:Shock, Hemorrhagic / Q000209:etiology*; D013577:Syndrome; D014057:Tomography, X-Ray Computed