Introduction: Median Arcuate Ligament Syndrome (MALS) is a rare cause of chronic abdominal pain in adult and infant. This syndrome typically occurs in thin women, who may present with epigastric pain and weight loss. The aim of this study was to report our first case of a 10-year-old girl patient treated with laparoscopic liberation of the celiac trunk artery in Median Arcuate Ligament Syndrome (MALS) in our Pediatric center. Case Report: A thin female of 10-year-old with chronic postprandial abdominal pain accompanying vegetative symptoms: nausea, vomiting, dizziness, tachycardia, weight loss and sweating. Her physical examination revealed epigastric pain to palpation and low weight. An abdominal ultrasound showed celiac artery flow of 116 cm/s and Resistance Index (RI) =0.76. In the same sense, an angiotomography was performed and showed a high-grade stenosis involving the origin of the celiac trunk and hemodynamic study was performed too. Results: The duration of the procedure was 154 minutes. The postoperative hospital recovery period was 3 days. No intraoperative or postoperative complications occurred: bleeding events, blood transfusions and stenosis of the celiac trunk. The patient accepted well the cosmetic aspect without pain. Conclusion: The outcome of the pediatric patient was satisfactory, and the laparoscopic procedure liberation of the celiac trunk was sufficient in this case. Laparoscopic liberation of celiac trunk is reliable and a less invasive procedure with good results and cosmetic aspect in pediatric patient.

Introduction: Portal hypertension is the main cause of morbidity and mortality in infant diagnosed of biliary atresia (BA) and cavernous deformation of the portal vein. Portal hypertension evolves as a result of increased intrahepatic vascular resistance, most commonly caused by a chronic liver disease. The clinical manifestations are ascites and bleeding owing the esophageal and gastric varices. The mortality rate per acute episode of bleeding is 5% to 19% in children. The aim of this work was to evaluate the clinical influence of rebleeding, refractory ascites, child-Pugh class (C.P) and shunt patency in infant underwent spleno-pancreatorenal (SPR) shunt in a case series in a pediatric reference medical center. Patients and Methods: Retrospective and observational work was performed owing clinical surveillance of C.P, shunt patency, rebleeding and ascites formation after SPR shunt procedure from December 2017 to November 2020. Of 16 shunts performed in this period, 3(18.7%) patients had SPR shunt. The three patients were females and the mean weight was 6.5kg. Outcomes and Results: The search identified three patients underwent surgical shunts of SPR less than 2-year-old. All of three patients had shunt patency in the first three months from the procedure. One patient had thrombosis of the shunt at fourth month from the operation. The three patients had improvement in the C.P class, 1 patient had infectious, rebleeding and ascites between 4 months from the procedure. Conclusion: The three patients had no experienced shunt complications in the first three months from the procedure.