Surgical treatment of median arcuate ligament syndrome: Case report and review of literature

Kotarac, M; Radovanović, Nebojša; Lekić, Nebojša; Raznatovic, Zoran; Djordjević, Vladimir; Lekić, Dragana; Sagić, Dragan

doi:10.2298/sarh1502074k

Cited by 9 publications

(16 citation statements)

References 19 publications

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“…This neuropathic compression may lead to a direct irritation and stimulation of sympathetic pain fibers and/or splanchnic vasoconstriction and ischemia. Additionally, vascular steal of blood flow, by larger collateral vessels, may lead to symptoms of celiac artery compression in patients with an occluded or compressed celiac trunk [3] , [7] . Both mechanisms may be involved [5] .…”

Section: Discussionmentioning

confidence: 99%

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Median arcuate ligament syndrome: A case report of a rare disease

Almeida

Coelho

Armas

et al. 2022

International Journal of Surgery Case Reports

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Introduction Median arcuate ligament syndrome (MALS) is a rare condition caused by the compression of the celiac trunk by the median arcuate ligament, which may trigger a typical symptom triad: postprandial abdominal pain, weight loss, nausea and vomiting. Clinical case A 58-year-old male was admitted to the emergency department due to abdominal pain, vomiting, fever and diarrhea. On admission, the patient was tachycardic, had abdominal distension, no peritoneal irritation signs, and a serum lactate level of 5 mmol/L. The computed tomography (CT) scan showed gastric and intestinal pneumatosis associated with pneumoportia. Conservative treatment with intravenous fluids, antibiotics and low molecular weight heparin, was initiated. The reassessment CT scan showed resolution of the gastric and intestinal pneumatosis and a severe stenosis of the initial portion of the celiac trunk with associated angulation. After recovery from the acute episode, an abdominal duplex ultrasound and an aortoiliac arteriography in forced inspiration and expiration was performed, corroborating the diagnosis of MALS. A laparoscopic decompression of the celiac trunk was performed. Discussion Symptoms of MALS closely mimic other abdominal disorders, and it should be considered in the differential diagnosis. Currently, there are no international guidelines on MALS diagnostic criteria. Treatment is focused on decompression of the median arcuate ligament constriction of the celiac artery, with or without celiac lymph node removal. Conclusion MALS diagnostic and therapeutic approach must be patient focused. Laparoscopic decompression is an effective treatment and can provide immediate symptomatic relief, associated with the benefits of the less invasive nature of the procedure.

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Section: Discussionmentioning

confidence: 99%

“…Celiac artery lumen compression and narrowing, especially during expiration, can cause ischemia of the involved organs and may trigger a typical symptom triad: postprandial abdominal pain, weight loss, nausea and vomiting [3] .…”

Section: Introductionmentioning

confidence: 99%

Median arcuate ligament syndrome: A case report of a rare disease

Almeida

Coelho

Armas

et al. 2022

International Journal of Surgery Case Reports

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“…MALS is a diagnosis of exclusion, and hence other visceral pain sources like chronic intestinal ischemia, superior mesenteric artery syndrome, irritable bowel syndrome, biliary causes, and ulcer diseases must be excluded [1,2]. This can be achieved with the help of imaging techniques like mesenteric duplex ultrasonography, CTA, magnetic resonance angiography, gastric tonometry, and mesenteric arteriography can all be used to view the celiac artery compression caused by MAL [1,11,12]. In patients with suspected MALS, a mesenteric ultrasound can be an excellent screening tool showing an elevation in peak systemic velocities during expiration, which normalizes on inspiration or upright posture [1].…”

Section: Discussionmentioning

confidence: 99%

An Atypical Presentation of Median Arcuate Ligament Syndrome

Rawala

Ahmed

Rizvi

2020

Cureus

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“…However, the precise mechanism underlying MAL syndrome is unclear [6]. The MAL should be considered in the cases of patients for whom a pancreaticoduodenectomy (PD) is planned.…”

Section: Discussionmentioning

confidence: 99%

Aneurysms of Pancreaticoduodenal Artery due to Median Arcuate Ligament Syndrome, Treated by Open Surgery and Laparoscopic Surgery

Tokuda

Sakuraba

Orita

et al. 2019

Case Reports in Surgery

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Introduction There are many possible causes of an abdominal visceral aneurysm, including the obstruction of the celiac artery by the median arcuate ligament (MAL). We report two cases of an aneurysm of the pancreaticoduodenal artery due to MAL syndrome that we treated surgically. Case Presentation Case 1: a 66-year-old Japanese woman was diagnosed with a rupture of an aneurysm of the inferior pancreaticoduodenal artery. Because of the difficulty of endovascular therapy, we performed an emergency operation. We chose an abdominal operation, and the postoperative course was uneventful. Case 2: a 75-year-old Japanese man presented at our hospital with acute abdominal pain, nausea, and cold sweat. Our experience of treating MAL syndrome in case 1 enabled us to diagnose the disease accurately. We chose laparoscopic surgery, and the postoperative course was uneventful. Discussion There are several treatment choices for an aneurysm of the pancreaticoduodenal artery due to MAL syndrome. We have performed only a release of the MAL for treatment, but it is difficult to conclude whether only releasing the MAL is enough to ensure a positive long-term prognosis. Regular follow-up is needed in such cases. Conclusion Laparoscopic surgery can be considered one of the options for MAL syndrome.

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Surgical treatment of median arcuate ligament syndrome: Case report and review of literature

Abstract: Despite the existing controversy concerning pathophysiological mechanism, the clinical presentation and treatment modalities of patients with MAL syndrome, it is evident that careful selection and adequate surgical treatment may significantly reduce symptoms in these patients.

Cited by 9 publications

References 19 publications

Median arcuate ligament syndrome: A case report of a rare disease

Median arcuate ligament syndrome: A case report of a rare disease

An Atypical Presentation of Median Arcuate Ligament Syndrome

Aneurysms of Pancreaticoduodenal Artery due to Median Arcuate Ligament Syndrome, Treated by Open Surgery and Laparoscopic Surgery

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