Hyper-dense fluid on plain computed tomography may reveal a ruptured aneurysm in patients with median arcuate ligament syndrome

  • Sawako KurumaEmail author
  • Masataka Kikuyama
  • Terumi Kamisawa
  • Kazuro Chiba
Case Report


Rupture of abdominal aneurysms associated with median arcuate ligament syndrome (MALS) is a serious condition and requires accurate diagnosis in a clinical setting. We examined three patients with this condition: two women aged 45 and 71 years, and a 61-year-old man. They complained of abdominal pain and had fluid collection around the duodenum. Plain computed tomography (CT) of the fluid collection revealed hyper density, which suggests the presence of blood. Moreover, contrast-enhanced CT revealed aneurysms in the pancreatic head area. Angiography revealed aneurysms of the branches of the gastroepiploic artery, which were treated by endovascular embolization in all patients. Thus, patients with abdominal pain and high-density fluid collection around the duodenum on plain CT may suffer from hemorrhage following rupture of MALS-associated aneurysms.


Median arcuate ligament syndrome Aneurysm Plain computed tomography 


Compliance with ethical standards

Conflict of interest

The authors declare that they have no conflict of interest.

Human rights

All procedures followed have been performed in accordance with the ethical standards laid down in the 1964 Declaration of Helsinki and its later amendments.

Informed Consent

Informed consent was obtained from all patients for being included in the study.


  1. 1.
    Kim EN, Lamb K, Relles D, et al. Median arcuate ligament syndrome—review of this rare disease. JAMA Surg. 2016;151:471–7.CrossRefGoogle Scholar
  2. 2.
    Suzuki K, Kashimura H, Sato M, et al. Pancreaticoduodenal artery aneurysms associated with celiac axis stenosis due to compression by median arcuate ligament and celiac plexus. J Gastroenterol. 1998;33:434–8.CrossRefGoogle Scholar
  3. 3.
    Coll DP, Ierardi R, Kerstein MD, et al. Aneurysms of the pancreaticoduodenal arteries: a change in management. Ann Vasc Surg. 1998;12:286–91.CrossRefGoogle Scholar
  4. 4.
    Drescher R, Köster O, Von Rothenburg T. Superior mesenteric artery aneurysm stent graft. Abdom Imaging. 2006;31:113–6.CrossRefGoogle Scholar
  5. 5.
    Upchurch GR Jr, Zelenock GBSJ. Splanchnic artery aneurysms. In: RB R, editor. Vascular surgery. 6th ed. Philadelphia: WB Saunders; 2005. pp. 1565–81.Google Scholar
  6. 6.
    Tarazov PG, Ignashov AM, Pavlovskij AV, et al. Pancreaticoduodenal artery aneurysm associated with celiac axis stenosis: combined angiographic and surgical treatment. Dig Dis Sci. 2001;46:1232–5.CrossRefGoogle Scholar
  7. 7.
    Katsura M, Gushimiyagi M, Takara H, et al. True aneurysm of the pancreaticoduodenal arteries: a single institution experience. J Gastrointest Surg. 2010;14:1409–13.CrossRefGoogle Scholar
  8. 8.
    Ducasse E, Roy F, Chevalier J, et al. Aneurysm of the pancreaticoduodenal arteries with a celiac trunk lesion: current management. J Vasc Surg. 2004;39:906–11.CrossRefGoogle Scholar
  9. 9.
    Flood K, Nicholson AA. Inferior pancreaticoduodenal artery aneurysms associated with occlusive lesions of the celiac axis: diagnosis, treatment options, outcomes, and review of the literature. Cardiovasc Interv Radiol. 2013;36:578–87.CrossRefGoogle Scholar
  10. 10.
    Ikeda O, Tamura Y, Nakasone Y, et al. Coil embolization of pancreaticoduodenal artery aneurysms associated with celiac artery stenosis: report of three cases. Cardiovasc Interv Radiol. 2007;30:504–7.CrossRefGoogle Scholar
  11. 11.
    Suzuki K, Tachi Y, Ito S, et al. Endovascular management of ruptured pancreaticoduodenal artery aneurysms associated with celiac axis stenosis. Cardiovasc Interv Radiol. 2008;31:1082–7.CrossRefGoogle Scholar
  12. 12.
    Koganemaru M, Abe T, Nonoshita M, et al. Follow-up of true visceral artery aneurysm after coil embolization by three-dimensional contrast-enhanced MR angiography. Diagn Interv Radiol. 2014;20:129–35.CrossRefGoogle Scholar
  13. 13.
    Tien Y-W, Kao H-L, Wang H-P. Celiac artery stenting: a new strategy for patients with pancreaticoduodenal artery aneurysm associated with stenosis of the celiac artery. J Gastroenterol. 2004;39:81–5.CrossRefGoogle Scholar
  14. 14.
    Kanno A, Satoh K, Kimura K, et al. Acute pancreatitis due to pancreatic arteriovenous malformation. Pancreas. 2006;32:422–5.CrossRefGoogle Scholar
  15. 15.
    Chang WL, Yang YH, Lin YT, et al. Gastrointestinal manifestations in Henoch-Schönlein purpura: a review of 261 patients. Acta Paediatr Int J Paediatr. 2004;93:1427–31.CrossRefGoogle Scholar
  16. 16.
    Miura M, Nomoto Y, Sakai H, et al. An aged patient with hsp nephritis: a case report and review of the literature. Intern Med. 1992;31:232–8.CrossRefGoogle Scholar
  17. 17.
    Proud G, Chamberlain J. Aneurysm formation on the small pancreatic arteries in association with coeliac axis compression. Ann R Coll Surg Engl. 1978;60:294–7.Google Scholar
  18. 18.
    Mora JD, Obst D. Coeliac-axis artery stenosis with aneurysmal calcification of the collateral supply. Australas Radiol. 1976;20:252–4.CrossRefGoogle Scholar
  19. 19.
    Stambo GW, Hallisey MJ, Gallagher JJ. Arteriographic embolization of visceral artery pseudoaneurysms. Ann Vasc Surg. 1996;10:476–80.CrossRefGoogle Scholar
  20. 20.
    Lossing AG, Grosman H, Mustard RA, et al. Emergency embolization of a ruptured aneurysm of the pancreaticoduodenal arcade. Can J Surg. 1995;38:363–5.Google Scholar

Copyright information

© Japanese Society of Gastroenterology 2019

Authors and Affiliations

  1. 1.Department of GastroenterologyTokyo Metropolitan Cancer and Infectious Diseases Komagome HospitalTokyoJapan

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