Surgical and Radiologic Anatomy

, Volume 40, Issue 4, pp 401–405 | Cite as

Pancreaticoduodenal artery aneurysms due to median arcuate ligament syndrome: what we need to know

  • A. Peyrottes
  • D. Mariage
  • P. Baqué
  • D. Massalou
Original Article


Median arcuate ligament (MAL) syndrome is a rare and poorly known cause of abdominal pain. MAL narrows the celiac artery (CA), resulting in true distal aneurysms, including pancreaticoduodenal artery (PDA) aneurysms. These aneurysms often have an aggressive course, as rupture can result in hemorrhagic shock. CT scan appears to be the most effective investigation for the diagnosis of PDA aneurysms and may reveal possible celiac artery compression. In this series, we describe four cases of PDA aneurysm: two ruptured aneurysms treated by an endovascular procedure and two non-ruptured aneurysms treated by surgery. It was also decided to treat CA stenosis in three of the four patients based on the clinical presentation (ruptured or non-ruptured) and the presence of peripancreatic collateral vessels on imaging. This strategy contrasts with the approach commonly reported in the literature, in which MAL section is mandatory due to the high risk of ischemia rather than the potential risk of recurrent aneurysm. Medical teams should be aware of this disease to improve diagnosis and patient management.


Median arcuate ligament Pancreaticoduodenal artery Aneurysm Surgery Radiological embolization 


Compliance with ethical standards

Conflict of interest

The authors declare that they have no conflict of interest.


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Copyright information

© Springer-Verlag France SAS, part of Springer Nature 2017

Authors and Affiliations

  • A. Peyrottes
    • 1
  • D. Mariage
    • 2
  • P. Baqué
    • 2
    • 3
  • D. Massalou
    • 2
    • 4
  1. 1.Rockefeller University Department of AnatomyClaude Bernard University of LyonVilleurbanneFrance
  2. 2.Acute Care Surgery Unit, Nice University Hospital, Pasteur 2 HospitalNice Sophia-Antipolis UniversityNiceFrance
  3. 3.Department of AnatomyNice Sophia-Antipolis UniversityNiceFrance
  4. 4.Applied Biomechanics LaboratoryUMRT24, IFSTTAR, Aix-Marseille UniversityMarseilleFrance

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