ABSTRACT
The median arcuate ligament syndrome is a rare disorder characterised by postprandial intestinal angina caused by compression of the coeliac artery by the median arcuate ligament. To date, the diagnosis and treatment of median arcuate ligament syndrome has remained controversial. To our knowledge, this is the first reported case of coeliac artery compression demonstrated on the four-dimensional wide-area detector CT angiogram.
Subject(s)
Celiac Artery/abnormalities , Constriction, Pathologic/diagnostic imaging , Four-Dimensional Computed Tomography , Ultrasonography, Doppler , Angiography , Celiac Artery/diagnostic imaging , Celiac Artery/surgery , Constriction, Pathologic/surgery , Contrast Media , Decompression, Surgical , Diagnosis, Differential , Female , Humans , Imaging, Three-Dimensional , Iohexol , Median Arcuate Ligament Syndrome , Middle AgedABSTRACT
BACKGROUND: Data on the effect of laparoscopic cholecystectomy (LC) on bowel function are controversial. The aim of this study was to determine the incidence of postcholecystectomy diarrhoea (PCD) and to identify patient characteristics that can be used as predictors in daily practice. METHODS: In 100 consecutive patients who underwent LC, data were obtained from clinical records and telephone survey 6-12 months postoperatively using standardized questionnaire. RESULTS: Postoperatively, 19 patients had diarrhoea, including 17 with new onset. Two patients with preoperative and postoperative diarrhoea were excluded from further analysis. Of 98 patients (mean age 58.1 +/- 19.4 years; 62 women) 34 were younger than 50 years, 33 were overweight (BMI 25-29.9 kg/cm(2)) and 29 were obese (BMI >30 kg/cm(2)). PCD was significantly associated with younger age (odds ratio (OR) 3.4; 95% confidence interval (CI) 1.16-9.96; P = 0.026), higher BMI (OR 1.1; 95%CI 1.01-1.18; P = 0.019) and food intolerance postoperatively (OR 3.4; 95%CI 1.18-10.08; P = 0.025). PCD was most common with combination of two or three of the following factors: age <50 years, male sex, BMI >25 kg/cm(2). The highest risk of developing PCD was observed in obese men younger than 50 (OR 26.1), and the lowest in persons aged >50 years with BMI <25 kg/cm(2) (OR = 0.8). CONCLUSION: After LC, 17% of patients reported troublesome new-onset diarrhoea. PCD was independently associated with younger age, especially <50, and postoperative food intolerance. Coexistence of age <50 with high BMI and male sex was predictive for PCD.
