Median Arcuate Ligament Syndrome Revealed by Splenic Infarcts

Chalh, Olaia; Billah, Nabil Moatassim; Nassar, Ittimad

doi:10.5334/jbsr.2781

Cited by 4 publications

(1 citation statement)

References 1 publication

Supporting

Mentioning

Contrasting

Order By: Relevance

“…One manifestation of this complication can be a spectrum of coagulopathies or vasculopathies, mainly affecting the organs supplied by the celiac trunk. For instance, a patient with symptomatology consistent with chronic mesenteric ischemia, along with splenic infarcts or pancreaticoduodenal aneurysms, superior mesenteric artery (SMA) thrombus, and retroperitoneal hemorrhage, should raise a question about examining the vasculature of the area for other abnormalities, to reach a definite diagnosis, which could include MALS, and also, treat the accompanying disease either via surgery or via interventional radiologic methods[ 11 - 15 ]. All these complications and clinical presentations from MALS are reported in the literature, and as the cases of MALS increase, more complications could be associated with it.…”

Section: Discussionmentioning

confidence: 99%

Median arcuate ligament syndrome often poses a diagnostic challenge: A literature review with a scope of our own experience

Giakoustidis¹,

Moschonas²,

Christodoulidis³

et al. 2023

World J Gastrointest Surg

View full text Add to dashboard Cite

The median arcuate ligament syndrome (MALS) is recognized as a rare clinical entity, characterized by chronic post-prandial abdominal pain, nausea, vomiting, and unintentional weight loss. Due to its vague symptomatology, it is mainly regarded as a diagnosis of exclusion. Patients can often be misdiagnosed for several years before a correct diagnosis is established, also due to a medical team’s clinical suspicion. We present a case series of two patients who suffered from MALS and were treated successfully. The first patient is a 32-year-old woman, presenting with post-prandial abdominal pain and weight loss that have lasted for the past ten years. The second patient, a 50-year-old woman, presented with similar symptomatology, with the symptoms lasting for the last five years. Both cases were treated by laparoscopic division of the median arcuate ligament fibers, which alleviated extrinsic pressure from the celiac artery. Previous cases of MALS were retrieved from PubMed, to assemble a better diagnostic algorithm and propose a treatment method of choice. The literature review suggests an angiography with a respiratory variation protocol as the diagnostic modality of choice, along with the laparoscopic division of the median arcuate ligament fibers as the proposed treatment of choice.

show abstract

Section: Discussionmentioning

confidence: 99%

Median arcuate ligament syndrome often poses a diagnostic challenge: A literature review with a scope of our own experience

Giakoustidis¹,

Moschonas²,

Christodoulidis³

et al. 2023

World J Gastrointest Surg

View full text Add to dashboard Cite

show abstract

Dieulafoy lesion with rare vascular complications: diagnostic and therapeutic approach

Abdoh,

Samara,

Zayed

et al. 2024

Journal of Surgical Case Reports

View full text Add to dashboard Cite

Dieulafoy lesions are a rare cause of gastrointestinal bleeding, characterized by an enlarged submucosal blood vessel that bleeds without visible abnormalities. The diagnosis is typically made via endoscopy, and treatment usually involves endoscopic therapy. This case involves a 46-year-old female who presented with upper gastrointestinal bleeding due to a Dieulafoy’s lesion, treated with band ligation and later embolization after the lesion was found to originate from the left phrenic artery. The patient developed rare complications, including splenic infarction and pleural effusion, which required additional management. Upon initial investigations, the patients had an accidental finding on computed tomography of asymptomatic celiac artery compression that was advised to take into consideration for the possibility of developing median arcuate ligament syndrome and was treated conservatively. The case highlights the diagnostic and therapeutic challenges of Dieulafoy’s lesion and underscores the need for individualized treatment and further research.

show abstract

Laparoscopic median arcuate ligament section for median arcuate ligament compression syndrome initially detected as splenic infarction: a case report

Takagi,

Morita,

Matsumoto

et al. 2024

surg case rep

View full text Add to dashboard Cite

Background Median arcuate ligament compression syndrome (MALS) causes upper abdominal pain and at times hemodynamic abnormalities in the pancreaticoduodenal region. Herein, we present a case of a 70 year-old man, initially diagnosed with splenic infarction and was successfully treated laparoscopically. Case presentation A 70-year-old man with abdominal pain admitted to our hospital. Abdominal-enhanced computed tomography revealed a poorly contrasted area in the spleen and stenosis at the root of the celiac artery. Arterial dilatation was observed around the pancreaticoduodenal arcade, however, no obvious aneurysm formation or arterial dissection was observed. Abdominal-enhanced magnetic resonance imaging indicated the disappearance of the flow void at the root of the celiac artery. The patient had no history of atrial fibrillation and was diagnosed with splenic infarction due to median arcuate ligament compression syndrome. We performed a laparoscopic median arcuate ligament section with five ports. Intraoperative ultrasonography showed a retrograde blood flow in the common hepatic artery and the celiac artery. After releasing the compression, the antegrade blood flow from the celiac artery to the splenic artery, and the common hepatic artery were visualized using intraoperative ultrasonography. The postoperative course of the patient was uneventful, and he was discharged on postoperative day 9. Postoperative computed tomography a month after surgery revealed no residual stenosis of the celiac artery or dilation of the pancreaticoduodenal arcade. Furthermore, the poorly contrasted area of the spleen improved. Conclusions Reports indicate that hemodynamic changes in the abdominal visceral arteries due to median arcuate ligament compression are related to the formation of pancreaticoduodenal aneurysms. In this case, median arcuate ligament compression syndrome caused splenic infarction by reducing blood flow to the splenic artery.

show abstract

Median Arcuate Ligament Syndrome Revealed by Splenic Infarcts

Abstract: Teaching Points: Splenic infarction is an extremely rare presentation of median arcuate ligament syndrome that requires a good analysis of celiac axis on computed tomography angiography in other to make a proper diagnosis and management.

Cited by 4 publications

References 1 publication

Median arcuate ligament syndrome often poses a diagnostic challenge: A literature review with a scope of our own experience

Median arcuate ligament syndrome often poses a diagnostic challenge: A literature review with a scope of our own experience

Dieulafoy lesion with rare vascular complications: diagnostic and therapeutic approach

Laparoscopic median arcuate ligament section for median arcuate ligament compression syndrome initially detected as splenic infarction: a case report

Contact Info

Product

Resources

About