61 years old female came to emergency room with severe abdominal pain at epigastric region. Patient had vomiting in past, two times during last 24 hours. She had tachycardia, low blood pressure at the time of admission.
After resuscitation, patient was investigated in the form of blood investigation and USG, suggestive of mild pancreatitis and low hemoglobin around 10.2 gram percentage, on USG ? fluid collection around the pancreas.
Patient was further investigated in the form of CT scan abdomen and pelvis with triple contrast study, it was suggestive of Hematoma at the lower border of the pancreas as well there was median arcuate ligament syndrome where Coeliac trunk was compressed by external pressure. There were multiple collateral vessels developed around the celiac trunk as well pancreas and duodenum. One of these collateral vessel was burst and the hematoma was developed.
Initially patient was managed conservatively and discharge at stable hemo dynamic condition. after 20 days of previous abdominal pain, patient was admitted for surgical intervention for median arcuate ligament syndrome release surgery.
With use of minimal invasive keyhole surgery median arcuate ligament was released (by laparoscopic method). Post operative patient had uneventful recovery and discharged on Fourth post operative day.
Learning lesson
Median arcuate ligament syndrome can be present with acute pancreatitis due to bleeding from Collateral vessels.
Author :- Dr Harshad N Soni
MS, FIAGES- Consultant GI & Laparoscopic Surgeon
Kaizen Hospital
