A Case of Aggravated Celiac Artery Stenosis after Pancreaticoduodenectomy Treated by Urgent Median Arcuate Ligament Release

We experienced a case of worsening of celiac artery (CA) stenosis after pancreaticoduodenectomy (PD) that was treated by urgent median arcuate ligament release (MALR), despite this procedure being judged unnecessary preoperatively and intraoperatively. A 64-year-old woman was found to have stenosis at the root of the CA, but no development of collateral circulation via the gastroduodenal artery (GDA) on a preoperative CT scan. An intraoperative GDA clamp test revealed no sign of decreased hepatic artery blood flow. Hence, we judged MALR not to be necessary at that time. However, on postoperative day 1, hepatopancreatic enzymes elevated markedly and a contrast CT scan revealed worsening of CA stenosis. This resulted in ischemia in the left lateral segment of the liver, stomach, remnant pancreas and spleen. Urgent MALR was performed, and immediate improvement of hepatic artery blood flow and alleviation of organ ischemia was confirmed.