scholarly journals Laparoscopic decompression as treatment for median arcuate ligament syndrome

2015 ◽  
Vol 97 (6) ◽  
pp. e96-e99 ◽  
Author(s):  
M Rubinkiewicz ◽  
PK Ramakrishnan ◽  
BM Henry ◽  
J Roy ◽  
A Budzyski
Keyword(s):  
Epigastric Pain ◽  
Treatment Options ◽  
Recurrent Abdominal Pain ◽  
Resonance Imaging ◽  
Median Arcuate Ligament ◽  
Median Arcuate Ligament Syndrome ◽  
Arcuate Ligament ◽  
Coeliac Trunk ◽  
Abdominal Bruit ◽  
Pain Patients

Median arcuate ligament syndrome (MALS) is a rare disorder due to coeliac trunk compression by the median arcuate ligament, resulting in coeliac artery stenosis characterised by chronic, recurrent abdominal pain. Patients with MALS are often middle-aged females presenting with a triad of postprandial epigastric pain, weight loss and abdominal bruit. It is a diagnosis of exclusion and confirmed by computed tomography or magnetic resonance imaging. Laparoscopic or open surgical decompression are the only treatment options in MALS. We present two cases of MALS treated by laparoscopic decompression as well as a literature review on this treatment.

scholarly journals Median Arcuate Ligament Syndrome

2018 ◽  
Vol 35 (2) ◽  
pp. 141-145 ◽  
Author(s):  
Evelyn Wu
Keyword(s):  
Epigastric Pain ◽  
Celiac Artery ◽  
Chronic Mesenteric Ischemia ◽  
Median Arcuate Ligament ◽  
Median Arcuate Ligament Syndrome ◽  
Celiac Artery Compression Syndrome ◽  
Compression Syndrome ◽  
Arcuate Ligament ◽  
Dunbar Syndrome ◽  
Abdominal Bruit

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.

scholarly journals Median arcuate ligament syndrome and a laparoscopic coeliac trunk first approach: a literature review and a proposed algorithm

2021 ◽  
Vol 8 (10) ◽  
pp. 3160
Author(s):  
Ji Chen ◽  
Anik Sarkar ◽  
Mouhannad Jaber
Keyword(s):  
Abdominal Pain ◽  
Literature Review ◽  
Rare Condition ◽  
Recurrent Abdominal Pain ◽  
Young Female ◽  
Review Of The Literature ◽  
Median Arcuate Ligament ◽  
Median Arcuate Ligament Syndrome ◽  
Arcuate Ligament ◽  
Coeliac Trunk

Median arcuate ligament syndrome (MALS) is a rare condition where chronic recurrent abdominal pain is related to the compressive effects of the median arcuate ligament on the coeliac artery. The mechanism behind this phenomenon is incompletely understood but thought to be both ischemic and neuropathic in nature. As a result, the management of this condition remains controversial. Furthermore, while there have been a variety of options both radiological and interventional described for the investigation of MALS, there has yet to be a consensus in how patients exhibiting symptoms should be assessed and worked up. In this article, we described a laparoscopic coeliac trunk first approach in a young female patient and following review of the literature, propose an algorithm that can be used in the assessment and management of suspected MALS.

scholarly journals New perspective on median arcuate ligament syndrome. Case reports

2021 ◽  
Vol 21 (86) ◽  
pp. e234-e236
Author(s):  
Andrzej Smereczyński ◽  
◽  
Katarzyna Kołaczyk ◽  
Radosław Kiedrowicz ◽  
◽  
...  
Keyword(s):  
Collateral Circulation ◽  
Case Reports ◽  
Causative Factor ◽  
Standing Position ◽  
Left Lobe ◽  
Median Arcuate Ligament ◽  
Median Arcuate Ligament Syndrome ◽  
Arcuate Ligament ◽  
Coeliac Trunk ◽  
New Perspective

A large group of patients with significant asymptomatic or low-symptomatic coeliac trunk stenosis require deeper consideration. On angiography, CT and MRI, 10–24% of examined patients are found to have their coeliac trunk compressed by the median arcuate ligament of the diaphragm. The associated median arcuate ligament syndrome, which is also called coeliac trunk compression syndrome or Dunbar syndrome, is rarely fully symptomatic. It is estimated that there are up to 7% of patients with such a clinical presentation. An asymptomatic or low-symptomatic course of the disease in patients with the syndrome is mainly explained by a developed collateral circulation, particularly involving the arterial arcades of the head of pancreas. In such cases, CT angiography detects collateral circulation in 22–69.6% of examined patients. The present authors often observed coeliac trunk blood flow to normalise in a standing position. According to them, the main causative factor for this phenomenon is the deflection of the coeliac trunk and its compression against the aorta by a lowered left lobe of the liver. The researchers observed it in many individuals; in this study, 5 cases are presented.

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
Keyword(s):  
Case Report ◽  
Ct Scan ◽  
Epigastric Pain ◽  
Celiac Trunk ◽  
Robotic Approach ◽  
Median Arcuate Ligament ◽  
Median Arcuate Ligament Syndrome ◽  
Clinical Diagnostic ◽  
Arcuate Ligament ◽  
History Of

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.

scholarly journals Treatment of median arcuate ligament syndrome: outcome of laparoscopic approach

2020 ◽  
Vol 33 (1) ◽  
Author(s):  
Julio Cezar Uili COELHO ◽  
Andréa Virmond El HOSNI ◽  
Christiano MarloPaggi CLAUS ◽  
Yan Sacha Hass AGUILERA ◽  
Gisele Pitrowsk ABOT ◽  
...  
Keyword(s):  
Weight Loss ◽  
Epigastric Pain ◽  
Clinical Manifestations ◽  
Laparoscopic Approach ◽  
Rare Condition ◽  
Laparoscopic Treatment ◽  
Median Arcuate Ligament ◽  
Median Arcuate Ligament Syndrome ◽  
Arcuate Ligament ◽  
Operative Findings

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.

scholarly journals Median Arcuate Ligament Syndrome: A Case Report

2018 ◽  
Vol 21 (2) ◽  
pp. 38-39
Author(s):  
Akash Chitrakar ◽  
Nirajan Subedi ◽  
Ramesh Singh Bhandari
Keyword(s):  
Computed Tomography ◽  
Case Report ◽  
Epigastric Pain ◽  
Celiac Artery ◽  
Celiac Axis ◽  
Median Arcuate Ligament ◽  
Median Arcuate Ligament Syndrome ◽  
Celiac Ganglion ◽  
Extrinsic Compression ◽  
Arcuate Ligament

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.  

scholarly journals Median arcuate ligament syndrome presenting with unintentional weight loss and epigastric pain

2019 ◽  
Vol 6 (10) ◽  
pp. 3839
Author(s):  
Mohammed Taher Mujahid ◽  
Virendra Kumar Soni ◽  
Rahul Saini
Keyword(s):  
Weight Loss ◽  
Rare Case ◽  
Surgical Intervention ◽  
Epigastric Pain ◽  
Rare Condition ◽  
Celiac Artery ◽  
Median Arcuate Ligament ◽  
Median Arcuate Ligament Syndrome ◽  
Extrinsic Compression ◽  
Arcuate Ligament

Median arcuate ligament syndrome is a rare condition characterized by extrinsic compression of celiac artery and celiac plexus by the median arcuate ligament. Patients typically present with chronic postprandial pain, nausea and occasionally, vomiting and weight loss. Treatment of this syndrome is laparoscopic or open surgical release of median arcuate ligament and gangliectomy. We report a rare case of median arcuate ligament syndrome in a patient who presented with abdominal pain and nausea. The patient was evaluated, investigated and planned for surgical intervention but the patient refused for treatment.

scholarly journals Spontaneous bleeding of the inferior pancreatic-duodenal artery in median arcuate ligament syndrome: do not miss the diagnosis

2019 ◽  
Vol 2019 (7) ◽  
Author(s):  
Eleni Rebelos ◽  
Alessandro Cipriano ◽  
Laura Ferrini ◽  
Silvia Trifirò ◽  
Niccolò Napoli ◽  
...  
Keyword(s):  
Color Doppler ◽  
Rare Condition ◽  
University Hospital ◽  
Median Arcuate Ligament ◽  
Median Arcuate Ligament Syndrome ◽  
Spontaneous Bleeding ◽  
Abdominal Ultrasonography ◽  
Luminal Narrowing ◽  
Arcuate Ligament ◽  
Coeliac Trunk

Abstract Median arcuate ligament syndrome (MALS) is a rare condition in which the median arcuate ligament (MAL) causes compression of the coeliac trunk. The chronic compression leads to coeliac trunk luminal narrowing and reduced blood supply to the abdominal splanchnic organs with possible local complications such as pseudo-aneurysms and spontaneous bleeding. Its incidence is probably underestimated due to the poor availability of color Doppler ultrasonography (CD-US), especially in an Emergency Department (ED) setting. A 44-year old woman presented to Pisa University Hospital ED with acute abdominal pain. An abdominal ultrasonography scan (US scan) was performed showing the presence of free liquid in the Douglas pouch. The abdominal computed tomography scan (CT scan) highlighted the presence of a large mesenteric hematoma. A CD-US revealed a significant stenosis of the coeliac artery. A selective angiography confirmed the diagnosis of MALS with a pseudo-aneurysm of the inferior pancreatic-duodenal artery, which was successfully embolized.

scholarly journals Atypical Presentation of Median Arcuate Ligament Syndrome in the Emergency Department

2019 ◽  
Vol 3 (4) ◽  
pp. 413-416 ◽  
Author(s):  
Abby Sapadin ◽  
Ryan Misek
Keyword(s):  
Emergency Department ◽  
Imaging Techniques ◽  
Treatment Options ◽  
Rare Condition ◽  
Celiac Artery ◽  
Median Arcuate Ligament ◽  
Median Arcuate Ligament Syndrome ◽  
Celiac Artery Compression Syndrome ◽  
Gi Symptoms ◽  
Arcuate Ligament

Celiac artery compression syndrome, also called median arcuate ligament syndrome (MALS), is a rare condition in which the diaphragmatic crura compresses the celiac axis. This results in a constellation of primarily gastrointestinal (GI) symptoms including nausea, vomiting, postprandial abdominal pain, and weight loss. It is typically a diagnosis of exclusion and may be detected via several imaging techniques including ultrasound and computed tomography angiography. We present an atypical case of MALS detected in the emergency department (ED). We review the symptomatology, diagnostic workup, and treatment options here, as well as discuss implications concerning revisits to the ED for recurrent GI symptoms.

scholarly journals Median Arcuate Ligament Syndrome: An Exceptional Cause of Abdominal Pain

2021 ◽  
Vol 5 (4) ◽  
pp. 177-179
Author(s):  
Satilmis Bilgin ◽  
◽  
Gulali Aktas ◽  
Ozge Kurtkulagi ◽  
Tuba Taslamacioglu Duman ◽  
...  
Keyword(s):  
Coronary Artery Disease ◽  
Weight Loss ◽  
Abdominal Pain ◽  
Laparoscopic Surgery ◽  
Treatment Options ◽  
Celiac Artery ◽  
Median Arcuate Ligament ◽  
Median Arcuate Ligament Syndrome ◽  
Arcuate Ligament ◽  
Artery Disease

Abstract: Median Arcuate Ligament Syndrome (MALS) is caused by the compression of celiac artery by median arcuate ligament and may cause serious symptoms; such as abdominal pain and weight loss. Here we present a 56 year old man with MALS, whom suffered of postprandial abdominal pain, weight loss, nausea and vomiting. Laparoscopic surgery revealed his symptoms after MALS diagnosis was established. In conclusion, MALS should be considered in the differential diagnosis of patients with complaints of postprandial abdominal pain, nausea and weight loss. Laparoscopic surgery could be as successful as other treatment options in these patients. Keywords: Median arcuate ligament syndrome, Postprandial abdominal pain, Laparoscopic surgery, Nausea, Celiac disease, Coronary artery disease.

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