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INTRODUCTION: Dunbar Syndrome, also known as median arcuate ligament syndrome (MALS), is a rare condition with a reported incidence of 2 per 100,000. It is characterized by an extrinsic compression of the celiac trunk, and should be considered when evaluating patients with abdominal pain of unknown etiology. CASE DESCRIPTION/METHODS: A 78 year old female presented with a complaint of epigastric discomfort that was post-prandial in nature, with associated weakness and early satiety. Her symptoms had been persistent for one year. Workup prior to her presentation included a normal nuclear medicine (NM) gastric emptying scan and normal NM hepatobiliary scan with CCK. A detailed history revealed that her pain was particularly worse after eating and was associated with early satiety. Laboratory results on admission were unremarkable. Contrast-enhanced CT scan of the abdomen and pelvis showed external compression and indentation of the superior aspect of the proximal celiac axis with post-stenotic dilation. Further diagnostic evaluation utilized end-inspiratory phase CT angiography of the abdomen, which showed an approximately 1 cm length segment of proximal celiac arterial narrowing, measuring 70% maximally at its origin. She was diagnosed with MALS after review of the CTA reconstructive images which showed moderate external compression of the celiac artery. DISCUSSION: MALS predominantly affects women between the ages of 30 and 50 and is marked by the hallmark feature of postprandial abdominal pain. Other signs and symptoms may include nausea, vomiting, and consequent weight loss from an inability to tolerate oral intake. Symptoms are thought to have both a vascular (mesenteric ischemia) as well as neurogenic component (somatic pain thought to originate from the splanchnic plexus). CT angiography and conventional angiography are considered to be gold standard imaging modalities for Dunbar syndrome. They demonstrate focal stenosis that has a characteristic hooked appearance due to the indentation of the celiac trunk on its superior surface. Imaging for an accurate diagnosis should ideally be performed during the end-inspiratory phase, as indentation of the celiac trunk may be seen normally during expiration. Additional imaging features may include post-stenotic dilation, prominent collateral vessels, and thickening of the median arcuate ligament. Treatment includes endovascular transluminal angioplasty and stent placement, as well as laparoscopic division of the arcuate ligament and resection of the celiac plexus.

Objective: Study conducted to know the prevalence of hyponatremia in cirrhosis and to evaluate the association between hyponatremia and complications in cirrhosis and its prognostic value. Methods: Patients were selected based on clinical examination, biochemical tests and ultrasound abdomen. All the patients were examined at the time of admission in the hospital and their serum sodium levels were checked and the patients were followed during their stay in the hospital. The severity of cirrhosis was assessed according to Child-Pugh score. MELD score and MELD-Na score were also calculated at the time of admission. Results: Study done on 100 cirrhotic patients, most common etiology for cirrhosis in this study was alcohol. 53% had hyponatremia(<136meq/l). Complications of cirrhosis were more in hyponatremia patients. Among the complications portal hypertension (57%), hepatic encephalopathy(89.28%), hepatorenal syndrome (42.8%) among hyponatremia cirrhotic patients are statistically significant(p<0.05). child pughturcot score, MELD, MELD-Na score are also high in hyponatremia. Mortality also seen more in severe hyponatremia. Conclusion: Dilutional hyponatremia is frequent in cirrhotic patients and associated with severe complications of liver cirrhosis like hepatic encephalopathy, hepatorenal syndrome. Hyponatremia is also associated with high morbidity and mortality in cirrhotic patients.

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