Image in transplantation surgery: median arcuate ligament in liver transplantation

Acta Chir Belg. 2020 Jun;120(3):217-219. doi: 10.1080/00015458.2019.1689649. Epub 2019 Nov 12.

Abstract

Low inserted median arcuate ligament (MAL) may cause extrinsic coeliac trunk compression and MAL syndrome (association of post-prandial epigastric pain, weight loss and nausea or vomiting). In liver transplantation (LT), liver graft arterial supply depends on the recipient's hepatic artery, as the gastro-duodenal artery has generally been ligated. A decreased graft arterial flow caused by coeliac trunk stenosis might induce hepatic artery thrombosis leading to graft loss. In this short report, the authors describe LT procedure during which recipient's hepatic artery pressure was dramatically decreased after ligature of the gastro-duodenal artery. Dissection and division of the MAL allowed to restore an excellent blood flow through the hepatic artery. This report reminds how important it is to be able to recognize and how to manage a stenosing MAL in LT.

Keywords: Liver transplantation; anatomy; complication; radiology; surgery.

Publication types

  • Case Reports

MeSH terms

  • Celiac Artery / diagnostic imaging
  • Diaphragm / diagnostic imaging*
  • End Stage Liver Disease / diagnostic imaging*
  • End Stage Liver Disease / surgery*
  • Humans
  • Ligaments / diagnostic imaging*
  • Liver Transplantation / adverse effects
  • Liver Transplantation / methods*
  • Male
  • Median Arcuate Ligament Syndrome / prevention & control*
  • Middle Aged