61 years old female came to emergency room with severe abdominal pain at epigastric region. Patient had vomiting in past, two times during last 24 hours. She had tachycardia, low blood pressure at the time of admission.
After resuscitation, patient was investigated in the form of blood investigation and USG, suggestive of mild pancreatitis and low hemoglobin around 10.2 gram percentage, on USG ? fluid collection around the pancreas.
Patient was further investigated in the form of CT scan abdomen and pelvis with triple contrast study, it was suggestive of Hematoma at the lower border of the pancreas as well there was median arcuate ligament syndrome where Coeliac trunk was compressed by external pressure. There were multiple collateral vessels developed around the celiac trunk as well pancreas and duodenum. One of these collateral vessel was burst and the hematoma was developed.
Initially patient was managed conservatively and discharge at stable hemo dynamic condition. after 20 days of previous abdominal pain, patient was admitted for surgical intervention for median arcuate ligament syndrome release surgery.
With use of minimal invasive keyhole surgery median arcuate ligament was released (by laparoscopic method). Post operative patient had uneventful recovery and discharged on Fourth post operative day.
Learning lesson
Median arcuate ligament syndrome can be present with acute pancreatitis due to bleeding from Collateral vessels.
Author :- Dr Harshad N Soni
MS, FIAGES- Consultant GI & Laparoscopic Surgeon
Kaizen Hospital
A 64-year-old patient presented with severe abdominal pain and nausea. On evaluation, he was diagnosed with acute severe pancreatitis with kidney failure, respiratory failure (Multiple organ failure), and severe infection with co-morbidity of hypertension, diabetes, liver disease, and Parkinson’s disease. Because of a fatal condition patient was admitted to KAIZEN hospital ICU.
The patient had difficulty breathing so oxygen support was given. Despite oxygen support, the patient had difficulty breathing hence he was kept on ventilator support (life-supporting system). Because of low blood pressure, his blood pressure was maintained with the help of inotropic medicines. Multiple antibiotics started to resolve the severe infection. Despite life life-supporting systems and multiple antibiotics, the infection couldn’t be controlled. In patients with multiple organ failure with life life-supporting system, surgery was planned with due risk of life to control infection. Two surgeries were performed with ventilator support. The infected pancreas and pus were removed and his intestine was brought was stoma (ileostomy). The patient had started feeding from tubes. After the long (45 days) of ventilator support, finally he recovered and the ventilator support was removed.
Gradually oral feeding started and discharged from the hospital after 50 days of hospitalization. All the effort of our Kaizen hospital team all consultants, critical care specialists, anesthetists, infectious disease specialists, nurses, physiotherapists, dietitians, and the entire support staff, patients discharged from the hospital.
Author :- Dr Sanjiv Haribhakti
M.Ch. GI Surgeon of Western India
Kaizen Hospital
