Wiki Median arcuate ligament syndrome


Safety Harbor, FL
Best answers
Help please. I have no idea on this one. The patient has some kind of celiac artery occulsion. Op note reads : An upper midline incision was made and the abdominal cavity was entered and the lateral attachments of the left lateral segment of the liver were taken down with the cautery and the left lateral lobe was retracted to the right. The stomach and esophagus were retracted to the left and the right vagus nerve was identified and retracted over with the stomach and esophagus. The incision was carried down to the crus at the aorta and the aortic surface above the celiac was exposed. I then worked down inferiorly and also identified the left gastric artery. Working from superior downward and following the left gastric back, I was able to identify clearly the celiac artery coming off of the aorta. All crural fibers and fascial fibers around the celiac were incised so that its full course until it divided into the splenic artery and left gastric artery, and hepatic artery was identified. When there was no evidence of any further compression the area was checked for hemostasis and a small piece of Surgicel was left in the area of the celiac axis. The left lateral segment of the liver was repositioned in a normal position. Then, attention was directed to the ligament of Treitz and approximately 6 inches distal to this I selected a point for placement of a feeding jejunostomy tube. Two 2-0 chromic pursestring sutures were placed and, through a left abdominal stab wound, a 14-French Foley catheter with 5 mL balloon was introduced, and this catheter was introduced through the 2 concentric 2-0 chromic pursestring sutures, and 3 mL was placed in the balloon to hold the tube within the jejunal lumen. A Stamm jejunostomy was carried out by tacking the jejunum up to the anterior abdominal wall with 3-0 silk sutures. The midline fascia was then closed with running #1 PDS suture. The subcutaneous fat was irrigated with saline and the skin was closed with skin staples. A gauze dressing was applied. The patient was awakened, extubated and taken to recovery room. Sponge and needle counts were correct times 2.

Not sure maybe exploratory laparotomy ???