Tanikawa T, Miyake K, Kawada M, Ishii K, Fushimi T, Urata N, Wada N, Nishino K, Suehiro M, Kawanaka M, Shiraha H, Haruma K, Fujiwara H, Yamatsuji T, Kawamoto H. Aneurysm rupture in median arcuate ligament syndrome leading to duodenal stenosis: A case report. World J Clin Cases 2025; 13(25): 106089 [DOI: 10.12998/wjcc.v13.i25.106089]
Corresponding Author of This Article
Tomohiro Tanikawa, PhD, Assistant Professor, Department of General Internal Medicine 2, Kawasaki Medical School, 2-6-1 Nakasange, Kita-ku, Okayama 7008505, Japan. t-tanikawa@med.kawasaki-m.ac.jp
Research Domain of This Article
Gastroenterology & Hepatology
Article-Type of This Article
Case Report
Open-Access Policy of This Article
This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Tomohiro Tanikawa, Keisuke Miyake, Mayuko Kawada, Katsunori Ishii, Takashi Fushimi, Noriyo Urata, Nozomu Wada, Ken Nishino, Mitsuhiko Suehiro, Miwa Kawanaka, Hidenori Shiraha, Ken Haruma, Hirofumi Kawamoto, Department of General Internal Medicine 2, Kawasaki Medical School, Okayama 7008505, Japan
Hiroyasu Fujiwara, Department of Diagnostic and Therapeutic Radiology, Kawasaki Medical School, Okayama 7008505, Japan
Tomoki Yamatsuji, Department of General Surgery, Kawasaki Medical School, Okayama 7008505, Japan
Author contributions: Tanikawa T, Miyake K, Kawada M, Ishii K, Fushimi T, Urata N, and Kawamoto H managed clinical care and patient diagnosis; Tanikawa T and Shiraha H drafted the manuscript; Wada N, Nishino K, Suehiro M, and Kawanaka M contributed to data collection and literature review; Fujiwara H and Yamatsuji T performed interventional radiology and surgical treatment; Kawamoto H critically revised the manuscript; all authors have read and approved the final manuscript.
Informed consent statement: Informed written consent was obtained from the patient.
Conflict-of-interest statement: The authors have no conflict of interest.
CARE Checklist (2016) statement: The authors have read the CARE Checklist (2016), and the manuscript was prepared and revised according to the CARE Checklist (2016).
Open Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Tomohiro Tanikawa, PhD, Assistant Professor, Department of General Internal Medicine 2, Kawasaki Medical School, 2-6-1 Nakasange, Kita-ku, Okayama 7008505, Japan. t-tanikawa@med.kawasaki-m.ac.jp
Received: February 17, 2025 Revised: April 9, 2025 Accepted: May 18, 2025 Published online: September 6, 2025 Processing time: 141 Days and 1.9 Hours
Abstract
BACKGROUND
A 56-year-old female presented with acute abdominal pain due to a ruptured pseudoaneurysm associated with median arcuate ligament syndrome (MALS), a rare condition caused by the compression of the celiac artery by the median arcuate ligament (MAL), potentially leading to ischemia, aneurysm formation, and rupture.
CASE SUMMARY
Computed tomography revealed a retroperitoneal hematoma, celiac artery stenosis, and two aneurysms in the inferior pancreaticoduodenal artery. Hemostasis was achieved using transcatheter arterial embolization. However, 15 days after embolization, the patient developed duodenal stenosis, manifesting as gastric distension and nausea without abdominal pain. Endoscopy revealed mucosal edema and luminal narrowing of the duodenum. Conservative treatment was ineffective, and the patient underwent MAL transection and gastrojejunostomy. She recovered uneventfully, and follow-up at 4 months showed complete resolution of duodenal stenosis and no recurrence.
CONCLUSION
This case highlights the importance of the early diagnosis and multidisciplinary management of MALS.
Core Tip: This case report describes a rare clinical course of median arcuate ligament syndrome (MALS) presenting with a ruptured aneurysm followed by duodenal stenosis after transcatheter arterial embolization. The patient required early surgical treatment, including gastrojejunostomy and decompression via median arcuate ligament transection. The combination of vascular and gastrointestinal complications highlights the importance of multidisciplinary management and timely intervention in patients with complex MALS.
