Median arcuate ligament syndrome, a rare case of chronic abdominal pain

The median arcuate ligament syndrome (MALS) is a rare disease characterized by abdominal pain caused by the external compression of the celiac artery by the median arcuate ligament. Surgical treatment is indicated, but given the non-specific symptoms, these patients are often hospitalized in the Departments of Internal Medicine where the diagnosis may be unknown. We present a case of MALS admitted to our Internal Medicine Division. An abdominal ultrasound in a woman with longstanding abdominal pain showed elevated celiac artery velocities during forced expiration. Computed tomography angiography (CTA) of the abdomen showed stenosis of the origin of the celiac artery and confirmed the diagnosis of MALS. MALS is a syndrome that has to be considered, especially in young women with abdominal pain of unclear etiology; evaluated by color Doppler ultrasound, in the presence of elevated hepatic artery velocities during forced expiration, the confirmatory test is CTA.

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Dunbar syndrome as a cause of chronic abdominal pain in a 24-year-old female

Case Reports in Internal Medicine ◽

10.5430/crim.v7n1p15 ◽

2020 ◽

Vol 7 (1) ◽

pp. 15

Author(s):

Zachary A Koenig ◽

Joel Yednock

Keyword(s):

Abdominal Pain ◽

Duplex Ultrasound ◽

Celiac Trunk ◽

Celiac Artery ◽

Median Arcuate Ligament ◽

External Compression ◽

Cross Sectional ◽

Downward Displacement ◽

Arcuate Ligament ◽

Dunbar Syndrome

External compression of the celiac artery by the median arcuate ligament is referred to as Dunbar syndrome, which is an eponym for celiac axis syndrome or median arcuate ligament syndrome. It is correlated with the archetypal triad of postprandial abdominal pain, weight loss of greater than 20 pounds, and an abdominal bruit on auscultation. This is often accompanied by epigastric tenderness, vomiting, and nausea. Given its lack of symptomatic specificity, Dunbar syndrome is a diagnosis of exclusion for unexplained episodic abdominal discomfort. Here, we present a unique case of a 24-year-old woman who experienced several months of chronic abdominal distress and an extensive workup prior to being diagnosed with Dunbar syndrome. The diagnosis was made via cross-sectional abdominal imaging and duplex ultrasound with respiratory maneuvers, which showed downward displacement of the celiac trunk, post-stenotic dilatation, and increased flow velocity on expiration. She underwent successful laparoscopic division of the median arcuate ligament which greatly alleviated her pain.

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Mini-invasive treatment of median arcuate ligament syndrome, a case report

Surgical Case Reports ◽

10.31487/j.scr.2019.02.012 ◽

2019 ◽

pp. 1-3

Author(s):

Maurizio Luca ◽

Marcodomenico Mazza

Keyword(s):

Abdominal Pain ◽

Therapeutic Option ◽

Surgical Techniques ◽

Laparoscopic Approach ◽

Safe Procedure ◽

Invasive Treatment ◽

Median Arcuate Ligament ◽

Median Arcuate Ligament Syndrome ◽

External Compression ◽

Arcuate Ligament

Introduction: Median arcuate ligament syndrome (MALS), also known as Dunbar syndrome or celiac artery compression syndrome, is a rare disorder due to external compression of the celiac trunk (CT) by the median arcuate ligament (MAL). The diagnosis is difficult and often one of exclusion, because of its nonspecific symptoms that overlap with other forms of chronic intestinal ischemia. Laparoscopic approach is considered to be an optimal therapeutic option. Material and Surgical Techniques: We describe the case of a 40-year-old woman who presented with a 4 years-long clinical history of postprandial abdominal pain, occasional vomiting and severe weight loss in the last year. An abdominal CT scan demonstrated an external compression of the CT and the patient underwent laparoscopic decompression by division of the MAL. Postoperative course was uneventful and the patient was discharged on the 5th postoperative day. Discussion: Despite being MALS a rare disease, it must be kept in the differential diagnosis of abdominal pain. Diagnosis is difficult and often requires 2nd level investigations. Laparoscopy can be useful both as a diagnostic and curative approach. The laparoscopic division of the MAL is a feasible and safe procedure, leading to an improved quality of life

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Celiac Artery Compression Syndrome

Case Reports in Gastrointestinal Medicine ◽

10.1155/2013/934052 ◽

2013 ◽

Vol 2013 ◽

pp. 1-3 ◽

Cited By ~ 2

Author(s):

Mohammed Muqeetadnan ◽

Syed Amer ◽

Ambreen Rahman ◽

Salman Nusrat ◽

Syed Hassan

Keyword(s):

Weight Loss ◽

Abdominal Pain ◽

Celiac Artery ◽

Rare Disorder ◽

Median Arcuate Ligament ◽

External Compression ◽

Celiac Artery Compression Syndrome ◽

Compression Syndrome ◽

Arcuate Ligament ◽

Celiac Artery Compression

Celiac artery compression syndrome is a rare disorder characterized by episodic abdominal pain and weight loss. It is the result of external compression of celiac artery by the median arcuate ligament. We present a case of celiac artery compression syndrome in a 57-year-old male with severe postprandial abdominal pain and 30-pound weight loss. The patient eventually responded well to surgical division of the median arcuate ligament by laparoscopy.

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Median Arcuate Ligament Syndrome: An Exceptional Cause of Abdominal Pain

National Journal of Health Sciences ◽

10.21089/njhs.54.0177 ◽

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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Median Arcuate Ligament Syndrome Confirmed with the Use of Intravascular Ultrasound

Texas Heart Institute Journal ◽

10.14503/thij-12-2495 ◽

2014 ◽

Vol 41 (1) ◽

pp. 57-60 ◽

Cited By ~ 7

Author(s):

Fernando Vazquez de Lara ◽

Christopher Higgins ◽

Eduardo A. Hernandez-Vila

Keyword(s):

Weight Loss ◽

Abdominal Pain ◽

Intravascular Ultrasound ◽

Celiac Artery ◽

Imaging Method ◽

Ganglion Block ◽

Median Arcuate Ligament ◽

Median Arcuate Ligament Syndrome ◽

Arcuate Ligament ◽

Initial Imaging

Median arcuate ligament syndrome, a rarely reported condition, is characterized by postprandial abdominal pain, nausea, vomiting, and weight loss. Its cause is unclear. We present the case of a 45-year-old woman who had intermittent chronic positional abdominal pain without weight loss. Magnetic resonance angiograms and computed tomograms revealed stenosis of the celiac artery. Ostial compression was confirmed on catheter angiographic and intravascular ultrasonographic images. Intravascular ultrasound revealed far greater stenosis than did the initial imaging methods and confirmed a diagnosis of median arcuate ligament syndrome. In lieu of surgery, the patient underwent a celiac ganglion block procedure that substantially relieved her symptoms. To our knowledge, this is the first report of the use of intravascular ultrasound in the diagnosis of median arcuate ligament syndrome. We recommend using this imaging method preoperatively in other suspected cases of the syndrome, to better identify patients who might benefit from corrective surgery.

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Median Arcuate Ligament Syndrome Clinical Presentation, Pathophysiology, and Management: Description of Four Cases

Gastrointestinal Disorders ◽

10.3390/gidisord3010005 ◽

2021 ◽

Vol 3 (1) ◽

pp. 44-50

Author(s):

Ihsan Al Bayati ◽

Mahesh Gajendran ◽

Brian R. Davis ◽

Jesus R. Diaz ◽

Richard W. McCallum

Keyword(s):

Abdominal Pain ◽

Celiac Artery ◽

Definitive Treatment ◽

Unknown Etiology ◽

Symptom Presentation ◽

Median Arcuate Ligament ◽

Median Arcuate Ligament Syndrome ◽

Long Term Follow Up ◽

Arcuate Ligament ◽

Upper Abdominal

Median arcuate ligament syndrome (MALS), otherwise called celiac artery compression syndrome (CACS), is an uncommon disorder that results from an anatomical compression of the celiac axis and/or celiac ganglion by the MAL. Patients typically present with abdominal pain of unknown etiology exacerbated by eating along with nausea, vomiting, and weight loss. MALS is a diagnosis of exclusion that should be considered in patients with severe upper abdominal pain, which does not correlate with the objective findings. The cardinal feature which is elicited in the diagnosis of MALS relies on imaging studies of the celiac artery, demonstrating narrowing during expiration. The definitive treatment is the median arcuate ligament’s surgical release to achieve surgical decompression of the celiac plexus by division of the MAL. This article describes our experience with this entity, focusing on symptom presentation, diagnostic challenges, and management, including long-term follow-up in four cases.

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