Median arcuate ligament syndrome (MALS), is a rare abdominal vascular compression syndrome caused by the compression of the proximal celiac trunk by the median arcuate ligament. According to many authors, a low insert...Median arcuate ligament syndrome (MALS), is a rare abdominal vascular compression syndrome caused by the compression of the proximal celiac trunk by the median arcuate ligament. According to many authors, a low insertion of the diaphragmatic crura or an abnormally high origin of the celiac trunk from the aorta can cause compression of the celiac artery. Usually, patients with MALS are asymptomatic. Computed tomography (CT) angiography of the abdomen is the main imaging modality to confirm the diagnosis. The coexistence of celiac trunk and superior mesenteric artery compression by the median arcuate ligament is rarely described in the literature. To our knowledge, until now, a simultaneous combination of three abdominal vascular compressions by the median arcuate ligament has never been described. From this case, we report a simultaneous compression of the celiac trunk, superior mesenteric artery, and renal arteries by the median arcuate ligament.展开更多
BACKGROUND Celiac trunk stenosis or occlusion is a common condition observed in patients undergoing pancreaticoduodenectomy(PD).The risk of upper abdominal organ ischemia or failure increases if the blood circulation ...BACKGROUND Celiac trunk stenosis or occlusion is a common condition observed in patients undergoing pancreaticoduodenectomy(PD).The risk of upper abdominal organ ischemia or failure increases if the blood circulation in the celiac arterial system is not maintained after the surgery.CASE SUMMARY We present two cases of elderly patients with distal cholangiocarcinoma and celiac trunk occlusion who underwent PD.We performed blood circulation modification preoperatively with transcatheter coil embolization of the arterial arcades of the pancreatic head via the superior mesenteric artery to develop collateral communication between the superior mesenteric artery and the common hepatic or splenic arteries to ensure arterial blood flow to the upper abdominal organs.The postoperative course was marked by delayed gastric emptying,but no major surgical complications,such as biliary or pancreatic fistula,or clinical,biochemical,or radiological evidence of ischemic disease,was observed.CONCLUSION Preoperative blood circulation modification may be a valid alternative procedure for elderly patients with celiac trunk occlusion who are ineligible for interventional or surgical revascularization.展开更多
The blood supply to the most of abdominal organs is provided by the branches of CT. The SMA supply caecum, ascends colon, all of the small bowels except the upper part of duodenum. Knowledge of variable anatomy of cel...The blood supply to the most of abdominal organs is provided by the branches of CT. The SMA supply caecum, ascends colon, all of the small bowels except the upper part of duodenum. Knowledge of variable anatomy of celiac axis and SMA may be useful in planning and executing radiological interventions such as celiacography and chemoembolization of hepatic and pancreatic tumors. In this study, the uncommon or low percentage cases of CT and SMA are presented in the light of clinical and embryological information. The celiac axises of a total of 30 adult corpses were examined. Dissections of abdominal region were performed in detail according to Cunningham’s manual. Angiographic images of 100 consecutive adult patients who underwent celiac MDCT angiography were evaluated. During autopsies, an incomplete celiac trunk or bifurcation of celiac trunk associated with the hepatomesenteric and gastrosplenic trunks (0.7%) and a celiacomesenteric trunk associated with high origin superior mesenteric artery and gastrosplenic trunk were detected (0.7%). During MDCT angiography, a case of total absence of celiac trunk associated with a hepatosplenomesenteric trunk (0.7%) and also a case of total absence of celiac trunk alone were observed (0.7%). The persistence or unusual development of ventral splanchnic arteries (VSAs) or ventral longitudinal anastomosis may result in variations or the unusual trunks related to celiac axis and SMA. The anomalous trunks of the CT may be result of either the persistence of some parts of the VSAs or ventral longitudinal anastomose that normally disappear or disappearance of parts that normally persist. The prevalence of unusual trunks of celiac axis and SMA in this study is quite low in literature. These abnormal vessels pose problems for surgeons and radiologists. Such vascular anomalies may cause clinical complications following surgical and radiological procedures such as resection of tumor of the pancreatic head, lymphadenectomy, coeliacography, aortic replacement with reimplantation of the trunk and coembolization of pancreatic and liver tumors.展开更多
OBJECTIVE To understand the characteristics of celiac trunk lymph-node metastases of thoracic esophageal carcinoma and their influence on prognosis of the patients, and to investigate a reasonable range for regional c...OBJECTIVE To understand the characteristics of celiac trunk lymph-node metastases of thoracic esophageal carcinoma and their influence on prognosis of the patients, and to investigate a reasonable range for regional celiac trunk lymph-node clearance. METHODS Clinical specimens of 241 patients receiving resection of a thoracic esophageal carcinoma were analyzed retrospectively. RIESULTS The rate of the patient celiac lymph-node metastases was 32.4%（78/241）, and of the lymph nodes examined, 9.8% were found to have metastasis. The extent of metastases adjacent to the common hepatic artery and celiac trunk and within the hepatoduodenal ligaments was 6.6%, 6.9% and 6.3%, respectively. The tumor site, extent of invasion and level of cell differentiation were the factors influencing lymph-node metastases, but they were unrelated to the length of the tumor. The overall rate of regional celiac recurrence for the patients 3 years after operation was 5.4%. The 3-year survivals for the patients with metastases of the celiac lymph nodes was 42.3%, which was lower compared to the non-metastatic patients （70.6%） （P〈0.01）. CONCLUSION Celiac lymph-node metastases are one of key factors affecting the prognosis of the patients receiving resection of esophageal cancer, and extensive clearance of the celiac-trunk lymph nodes can reduce the rate of postoperative regional metastases.展开更多
Background: Surgical treatment of upper mesocolic organs is improved by preoperative diagnosis of anatomical variants of celiac trunk. According to the literature, these anatomical variants are little known in sub-Sah...Background: Surgical treatment of upper mesocolic organs is improved by preoperative diagnosis of anatomical variants of celiac trunk. According to the literature, these anatomical variants are little known in sub-Saharan Africa. Purpose: To evaluate the prevalence of anatomical variants of celiac trunk in relation to its branching. Materials and methods: This was a cross-sectional study of descriptive type. It retrospectively evaluated 160 abdominal contrast enhanced CT-scan, from patients attending Yalgado OUEDRAOGO teaching hospital, from 1 January 2015 to 30 September 2016. Patients with a history of heavy abdominal surgery were excluded. Images obtained by 64-row CT-scan were analyzed for anatomical variants of the celiac trunk. Results: One hundred and twenty-eight patients (80%) had a classic anatomical configuration of celiac trunk, while thirty-two (20%) had at least one anatomical variant. Two anatomical variants were found in fifteen patients (9.4%) while five other patients (3.1%) had more than two variants. The most frequent anatomical variant was the hepato-splenic bifurcation, found in fourteen patients (8, 8%). It was followed by common celiac and mesenteric trunk, and then collateral arteries, in particular left hepatic artery and right lower diaphragmatic artery, each with three patients (1.9%). Conclusion: Anatomical variants related to celiac trunk branching, are as frequent in our study as in the literature. However, the two most common anatomical variants were hepato-splenic bifurcation and common celiac and mesenteric trunk.展开更多
Here we present the case of a 79-year-old woman who complained of acute abdominal pain,vomiting and diarrhoea.Laboratory exams demonstrated a severe metabolic imbalance.Abdominal X-rays showed bowel overdistension and...Here we present the case of a 79-year-old woman who complained of acute abdominal pain,vomiting and diarrhoea.Laboratory exams demonstrated a severe metabolic imbalance.Abdominal X-rays showed bowel overdistension and pneumatosis of the stomach wall.Abdominal tomography revealed infarction of the stomach,duodenum and small bowel due to thrombosis of the celiacomesenteric trunk.Exploratory laparotomy revealed ischemia of the liver,spleen infarction and necrosis of the gastro-intestinal tube(from the stomach up to the first third of the transverse colon).No further surgical procedures were performed.The patient died the following day.To our knowledge,this is the first reported case about severe gastro-intestinal ischemia due to thrombosis of the celiacomesenteric trunk,a rare anatomic variation of the gastrointestinal vascularisation.展开更多
文摘Median arcuate ligament syndrome (MALS), is a rare abdominal vascular compression syndrome caused by the compression of the proximal celiac trunk by the median arcuate ligament. According to many authors, a low insertion of the diaphragmatic crura or an abnormally high origin of the celiac trunk from the aorta can cause compression of the celiac artery. Usually, patients with MALS are asymptomatic. Computed tomography (CT) angiography of the abdomen is the main imaging modality to confirm the diagnosis. The coexistence of celiac trunk and superior mesenteric artery compression by the median arcuate ligament is rarely described in the literature. To our knowledge, until now, a simultaneous combination of three abdominal vascular compressions by the median arcuate ligament has never been described. From this case, we report a simultaneous compression of the celiac trunk, superior mesenteric artery, and renal arteries by the median arcuate ligament.
文摘BACKGROUND Celiac trunk stenosis or occlusion is a common condition observed in patients undergoing pancreaticoduodenectomy(PD).The risk of upper abdominal organ ischemia or failure increases if the blood circulation in the celiac arterial system is not maintained after the surgery.CASE SUMMARY We present two cases of elderly patients with distal cholangiocarcinoma and celiac trunk occlusion who underwent PD.We performed blood circulation modification preoperatively with transcatheter coil embolization of the arterial arcades of the pancreatic head via the superior mesenteric artery to develop collateral communication between the superior mesenteric artery and the common hepatic or splenic arteries to ensure arterial blood flow to the upper abdominal organs.The postoperative course was marked by delayed gastric emptying,but no major surgical complications,such as biliary or pancreatic fistula,or clinical,biochemical,or radiological evidence of ischemic disease,was observed.CONCLUSION Preoperative blood circulation modification may be a valid alternative procedure for elderly patients with celiac trunk occlusion who are ineligible for interventional or surgical revascularization.
文摘The blood supply to the most of abdominal organs is provided by the branches of CT. The SMA supply caecum, ascends colon, all of the small bowels except the upper part of duodenum. Knowledge of variable anatomy of celiac axis and SMA may be useful in planning and executing radiological interventions such as celiacography and chemoembolization of hepatic and pancreatic tumors. In this study, the uncommon or low percentage cases of CT and SMA are presented in the light of clinical and embryological information. The celiac axises of a total of 30 adult corpses were examined. Dissections of abdominal region were performed in detail according to Cunningham’s manual. Angiographic images of 100 consecutive adult patients who underwent celiac MDCT angiography were evaluated. During autopsies, an incomplete celiac trunk or bifurcation of celiac trunk associated with the hepatomesenteric and gastrosplenic trunks (0.7%) and a celiacomesenteric trunk associated with high origin superior mesenteric artery and gastrosplenic trunk were detected (0.7%). During MDCT angiography, a case of total absence of celiac trunk associated with a hepatosplenomesenteric trunk (0.7%) and also a case of total absence of celiac trunk alone were observed (0.7%). The persistence or unusual development of ventral splanchnic arteries (VSAs) or ventral longitudinal anastomosis may result in variations or the unusual trunks related to celiac axis and SMA. The anomalous trunks of the CT may be result of either the persistence of some parts of the VSAs or ventral longitudinal anastomose that normally disappear or disappearance of parts that normally persist. The prevalence of unusual trunks of celiac axis and SMA in this study is quite low in literature. These abnormal vessels pose problems for surgeons and radiologists. Such vascular anomalies may cause clinical complications following surgical and radiological procedures such as resection of tumor of the pancreatic head, lymphadenectomy, coeliacography, aortic replacement with reimplantation of the trunk and coembolization of pancreatic and liver tumors.
文摘OBJECTIVE To understand the characteristics of celiac trunk lymph-node metastases of thoracic esophageal carcinoma and their influence on prognosis of the patients, and to investigate a reasonable range for regional celiac trunk lymph-node clearance. METHODS Clinical specimens of 241 patients receiving resection of a thoracic esophageal carcinoma were analyzed retrospectively. RIESULTS The rate of the patient celiac lymph-node metastases was 32.4%（78/241）, and of the lymph nodes examined, 9.8% were found to have metastasis. The extent of metastases adjacent to the common hepatic artery and celiac trunk and within the hepatoduodenal ligaments was 6.6%, 6.9% and 6.3%, respectively. The tumor site, extent of invasion and level of cell differentiation were the factors influencing lymph-node metastases, but they were unrelated to the length of the tumor. The overall rate of regional celiac recurrence for the patients 3 years after operation was 5.4%. The 3-year survivals for the patients with metastases of the celiac lymph nodes was 42.3%, which was lower compared to the non-metastatic patients （70.6%） （P〈0.01）. CONCLUSION Celiac lymph-node metastases are one of key factors affecting the prognosis of the patients receiving resection of esophageal cancer, and extensive clearance of the celiac-trunk lymph nodes can reduce the rate of postoperative regional metastases.
文摘Background: Surgical treatment of upper mesocolic organs is improved by preoperative diagnosis of anatomical variants of celiac trunk. According to the literature, these anatomical variants are little known in sub-Saharan Africa. Purpose: To evaluate the prevalence of anatomical variants of celiac trunk in relation to its branching. Materials and methods: This was a cross-sectional study of descriptive type. It retrospectively evaluated 160 abdominal contrast enhanced CT-scan, from patients attending Yalgado OUEDRAOGO teaching hospital, from 1 January 2015 to 30 September 2016. Patients with a history of heavy abdominal surgery were excluded. Images obtained by 64-row CT-scan were analyzed for anatomical variants of the celiac trunk. Results: One hundred and twenty-eight patients (80%) had a classic anatomical configuration of celiac trunk, while thirty-two (20%) had at least one anatomical variant. Two anatomical variants were found in fifteen patients (9.4%) while five other patients (3.1%) had more than two variants. The most frequent anatomical variant was the hepato-splenic bifurcation, found in fourteen patients (8, 8%). It was followed by common celiac and mesenteric trunk, and then collateral arteries, in particular left hepatic artery and right lower diaphragmatic artery, each with three patients (1.9%). Conclusion: Anatomical variants related to celiac trunk branching, are as frequent in our study as in the literature. However, the two most common anatomical variants were hepato-splenic bifurcation and common celiac and mesenteric trunk.
文摘Here we present the case of a 79-year-old woman who complained of acute abdominal pain,vomiting and diarrhoea.Laboratory exams demonstrated a severe metabolic imbalance.Abdominal X-rays showed bowel overdistension and pneumatosis of the stomach wall.Abdominal tomography revealed infarction of the stomach,duodenum and small bowel due to thrombosis of the celiacomesenteric trunk.Exploratory laparotomy revealed ischemia of the liver,spleen infarction and necrosis of the gastro-intestinal tube(from the stomach up to the first third of the transverse colon).No further surgical procedures were performed.The patient died the following day.To our knowledge,this is the first reported case about severe gastro-intestinal ischemia due to thrombosis of the celiacomesenteric trunk,a rare anatomic variation of the gastrointestinal vascularisation.
