Median Arcuate Ligament Syndrome: It Is Not Always Gastritis

Abstract

Median arcuate ligament syndrome is a rare disorder that is clinically characterized by the triad of postprandial abdominal pain, weight loss, and often an abdominal bruit due to compression of the celiac artery by the median arcuate ligament. Given the nonspecific symptoms, this is a rare and difficult diagnosis to obtain. We present a patient with nonspecific abdominal pain in whom etiology was ultimately determined to be median arcuate ligament syndrome.

Laparoscopic Management of Celiac Artery Compression Syndrome (Dunbar Syndrome): Our Experience of 6 Cases

“…An abdominal bruit is reported to be present in many| patients with MAL syndrome. Sunkara T et al 9 and Watari T et al 10 and many other authors have reported presence of bruit in patients with MAL syndrome whereas bruit was absent in patients reported by Kuruvilla A et al 11 The diagnosis of MAL can be suspected in young patients particularly females presenting with post-prandial abdominal pain, vomiting and weight loss. Abdominal Bruit may or may not be present.…”

Holding the Secret: A Rare Case of Nausea and Vomiting Due to Ligamentous Compression of the Celiac Axis

“…Results following surgery may be varied. Many patients (up to 60%-70%) have successful resolution of symptoms however since post-operative pain may persist following intervention, pain may not resolve for several months following surgery [3,4].…”

An Atypical Presentation of Median Arcuate Ligament Syndrome

“…The ligament passes above the origin of the celiac artery and is a direct continuation of the posterior diaphragm that wraps over the aorta [1]. In 10% to 24% of the population, an unusually low-lying MAL passes anterior to the celiac artery causing some degree of stenosis triggering abdominal symptoms [1,2,6]. Celiac trunk is most prone to constriction by MAL when the distance between the celiac trunk root and the diaphragmatic crura is short, i.e, an abnormally low-lying diaphragmatic MAL [7,8].…”

“…Median arcuate ligament syndrome (MALS), also known as coeliac axis compression syndrome or Dunbar syndrome, is a rare disorder resulting from the external compression of the celiac trunk by the MAL [1,4]. MALS is characterized by the triad of postprandial abdominal pain, weight loss, and often an abdominal bruit produced due to celiac artery compression by MAL [6].…”

“…Most patients have incidental findings diagnosed on computed tomography (CT) scan and require no treatment [7]. Kuruvilla et al mention the use of a mesenteric ultrasound during deep expiration as the modality makes use of the increased blood flow velocity developed in areas compressed due to celiac artery stenosis/constriction [6].…”