scholarly journals Robotic approach to treat Median Arcuate Ligament syndrome: a case report

2020 ◽  
Vol 2020 (5) ◽  
Author(s):  
Roberto Bustos ◽  
Michail Papamichail ◽  
Alberto Mangano ◽  
Valentina Valle ◽  
Pier Cristoforo Giulianotti

Abstract The Median Arcuate Ligament (MAL) syndrome is the symptomatic compression of the celiac trunk by the MAL and other ganglionic periaortic tissue. Despite its rarity, this condition is significant from a clinical, diagnostic and management standpoint and it is usually a diagnosis of exclusion. A 61-year-old female with history of intermittent postprandial epigastric pain was diagnosed with MAL syndrome during CT scan imaging (no other causes of pain were identified). Patient successfully underwent robotic MAL release with symptoms improvement after surgery. The robotic approach is feasible and may allow a very precise and delicate dissection with release of the MAL.

2013 ◽  
Vol 2013 ◽  
pp. 1-5 ◽  
Author(s):  
Chris Klonaris ◽  
Emmanouil Psathas ◽  
Athanasios Katsargyris ◽  
Stella Lioudaki ◽  
Achilleas Chatziioannou ◽  
...  

Inferior pancreaticoduodenal artery (IPDA) aneurysms are uncommon, representing nearly 2% of all visceral aneurysms, and sporadically associated with celiac artery stenosis. Multiple IPDA aneurysms have been rarely reported. We report a case of a 53-year-old female patient with a history of prior pancreatitis, who presented with two IPDA aneurysms combined with median arcuate ligament-syndrome-like stenosis of the celiac trunk. The patient was treated successfully with coil embolization under local anesthesia. The procedure is described and illustrated in detail and the advantages and technical considerations of such an approach are also being discussed.


2018 ◽  
Vol 21 (2) ◽  
pp. 38-39
Author(s):  
Akash Chitrakar ◽  
Nirajan Subedi ◽  
Ramesh Singh Bhandari

Median arcuate ligament (MAL) syndrome results from extrinsic compression of the celiac axis and or celiac ganglion by the MAL and diaphragmatic crura. A seventy five years lady presented with post prandial epigastric pain for 6 months. She had undergone considerable investigations for other diagnoses before an abdominal computed tomography (CT) revealed median arcuate ligament impinging celiac artery at its origin. She successfully underwent laparotomy and release of median arcuate ligament.  


Author(s):  
Giacomo Coppalini ◽  
◽  
Enrico Giustiniano ◽  
Fulvio Nisi ◽  
Carlo Castoro ◽  
...  

Dunbar Syndrome (DS), also known as Median Arcuate Ligament (MAL) syndrome, is a rare disease in which the celiac trunk is compressed by a fibrous attachment at the diaphragmatic crura causing abdominal angina with a large spectrum of symptoms including nausea, vomiting, weight loss, and postprandial epigastric pain.


1970 ◽  
Vol 3 (1) ◽  
pp. 67-76
Author(s):  
Leandro Urquiza Marques Alves Da Silva ◽  
Rodrigo Ribeiro Tiengo

Introdução: A Síndrome do Ligamento Arqueado Mediano, também denominada Síndrome da Compressão do Tronco Celíaco decorre da compressão do Tronco Celíaco pelo ligamento Arqueado Mediano, comprometendo o fluxo sanguíneo e causando sintomas. O grau de compressão varia com as fases do ciclo respiratório, devido a mobilidade das estruturas, sendo maior na expiração. Casuística: O trabalho relata o caso de uma paciente com quadro de dor abdominal crônica, mal definida, há cerca de 25 anos. Os sintomas eram desencadeados pela ingestão de alimentos. Foram realizados exames de imagem para investigação diagnóstica que demonstraram alterações típicas da compressão do Tronco Celíaco pelo Ligamento Arqueado Mediano, como o aspecto em “gancho” na angiotomografia multislice do abdome e aumento das velocidades sistólica e diastólica, no estudo ultrassonográfico com Doppler. Discussão: Diante do quadro clínico apresentado pela paciente, estabeleceu-se o diagnóstico da Síndrome do Ligamento Arqueado Mediano, caracterizada pelos achados imagenológicos citados, associados aos sintomas de dor abdominal crônica, mal definida, geralmente desencadeada pela alimentação. Os estudos de imagem também permitiram a exclusão de outras patologias que poderiam ser a causa das dores da paciente. Conclusão: Os achados de imagem são fundamentais para o diagnóstico da síndrome, pois quando presentes têm alta especificidade e ainda podem excluir outras condições que poderiam causar dor abdominal crônica. O tratamento consiste na secção do ligamento, sua indicação ainda permanece controversa na literatura.Palavras chave: Ligamento Arqueado Mediano, tronco celíaco, compressão vascular.ABSTRACTIntroduction: The Median Arcuate Ligament Syndrome, also called Syndrome Compression of the results from of Celiac Trunk compression by the ligament Arched Median, compromising blood flow and causing symptoms. The degree of compression varies with the phases of the respiratory cycle, because of the mobility of the structures, being greater during expiration. Case report: The case reports a history of a patient with chronic abdominal pain, ill-defined, about 25 years. The symptoms were triggered by the ingestion of food .Performed imaging exams that showed changes typical of compression of the Celiac Trunk by Median arcuate ligament, as the appearance of "hook" on multislice CT angiography of the abdomen and increase in systolic and diastolic velocities at Doppler ultrasonographic examinations. Discussion: Given the clinical history presented by the patient, we established the diagnosis of Median Arcuate Ligament Syndrome, characterized by the above imaging findings and symptoms associated with chronic abdominal pain, ill-defined, usually triggered by food. Imaging studies also allowed the exclusion of other pathologies that could be the cause of the patient’s pain. Conclusion: The imaging findings are essential for the diagnosis of the syndrome, because they have high specificity and can still rule out other conditions that could cause abdominal pain chronic. The treatment consists in section of the ligament, its indication is still controversial in literature. Key words: Arcuate ligament, celiac trunk, vascular compression 


Author(s):  
Rakshith Shetty ◽  
K. Subramanyam ◽  
Chinthu Sara Jacob

Median arcuate ligament syndrome (MALS) is a rare entity characterized by extrinsic compression of the celiac artery and symptoms of postprandial epigastric pain, nausea, vomiting, and weight loss mimicking mesenteric ischemia. The following case illustrates a rare cause of abdominal pain, where this young woman was found to have celiac trunk stenosis , secondary to compression of the trunk by the median arcuate ligament. She underwent a successful stenting to the ostial celiac trunk, thus reliving her symptomatically. Decompression of the celiac artery is the general approach. Usually post PTA, once revascularisation is achieved, 75% of the patients remain asymptomatic at follow up.


2018 ◽  
Vol 50 (4) ◽  
pp. e410
Author(s):  
M.T. Illiceto ◽  
G. Lisi ◽  
M. Filippone ◽  
N. Marino ◽  
M. Di Pietro ◽  
...  

Author(s):  
Julio Cezar Uili COELHO ◽  
Andréa Virmond El HOSNI ◽  
Christiano MarloPaggi CLAUS ◽  
Yan Sacha Hass AGUILERA ◽  
Gisele Pitrowsk ABOT ◽  
...  

ABSTRACT Background: Median arcuate ligament syndrome(MALS) is a rare condition thatmay cause significant clinical manifestations, including abdominal pain and weight loss. Its diagnosis may be difficult and very often delayed. The laparoscopic approach became the standard treatment of MALS. Aim: To assess the outcome of laparoscopic treatment in patients with MALS. Method: The data of sixpatients with MALS who were subjected to laparoscopic sectioning of the median arcuate ligament were retrospectively reviewed.The following data were evaluated: age, gender, clinical and diagnostic tests findings, ASA score, operative findings and complications, postoperative complications and mortality, hospital stay duration, and hospital readmission.The diagnosis of MALS was established by CT angiography and/or MR angiography. Results: There were four (66.7%) women and two (33.3%) men aged from 32 to 60 years. The main symptoms were epigastric pain (100%) and weight loss (66.7%). The findings of high-grade stenosis of the proximal celiac axis and poststenotic dilation confirmed on angiography confirmed the diagnosis in all patients. Surgical procedure was uneventful in all patients. The only postoperative complication was urinary retention that occurred in a male. At three-month follow-up, all patients were asymptomatic. Conclusion: Laparoscopic treatment of MALS is safe and effective in relieving the clinical manifestations of patients.


2020 ◽  
Vol 7 (6) ◽  
pp. 2016
Author(s):  
Preethi Subramanian ◽  
Rajan Vaithianathan

Median arcuate ligament syndrome is an uncommon cause for abdominal pain and weight loss, caused by median arcuate ligament compressing the celiac plexus or artery. Median arcuate ligament is the continuation of the posterior diaphragm which passes superior to celiac artery and surrounds the aorta. In this case report, A 67 year old male presented with complaints of sudden onset chest pain and loss of weight for the past 6 months. CECT thorax and abdomen it showed features of focal stenosis of coeliac axis and post stenotic dilation of the coeliac trunk suggesting median arcuate ligament syndrome. Laparoscopic median arcuate ligament release was done to relieve the patient from symptoms. Diagnosis of median arcuate ligament syndrome should be considered in a patient presenting with chest pain and weight loss with normal cardiac status and unexplained etiology.


2018 ◽  
Vol 35 (2) ◽  
pp. 141-145 ◽  
Author(s):  
Evelyn Wu

Median arcuate ligament syndrome (MALS) is a condition characterized by pain in the abdominal region attributed to compression of the celiac artery by the median arcuate ligament of the diaphragm during expiration. MALS is also known as celiac artery compression syndrome, celiac axis syndrome, or Dunbar syndrome. Pain may result from the tight pressing on the celiac nerves in the area. The patient usually presents with symptoms such as postprandial epigastric pain, weight loss, and, occasionally, an abdominal bruit. Furthermore, some individuals may experience nausea and vomiting. It may be an etiology of a rare disorder, chronic mesenteric ischemia.


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