Compression of the Celiac Artery by the Median Arcuate Ligament: Multidetector Computed Tomography Findings and Characteristics

Başkan, Özdil; Kaya, Emre; Güngören, Fatma Zeynep; Erol, Cengiz

doi:10.1016/j.carj.2015.01.001

Cited by 30 publications

(23 citation statements)

References 17 publications

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“…Origin of celiac trunk occlusion could be classified under intrinsic, congenital, neoplastic, arteriosclerosis, and extrinsic: which is mostly by MAL [9]. This compression was reported to exacerbate when the diaphragm draws down during expiration when the aorta with its branches move over the MAL, further compressing the celiac trunk and therefore resulting in visceral ischemia followed by postprandial abdominal pain [1,9]. Only 1% of patients will experience severe compression, continuing through inspiration [9].…”

Section: Discussionmentioning

confidence: 99%

“…However, a lateral view of angiography remains the gold standard for diagnosis, demonstrating focal constriction of the celiac artery with post stenotic dilations followed by an increment in collaterals from the superior mesenteric artery [1]. This is known as the characteristic hooked appearance visible on CTA and differentiates it from an atherosclerotic lesion due to the absence of calcification and intimal thickening in MALS [1,9,13].…”

Section: Discussionmentioning

confidence: 99%

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An Atypical Presentation of Median Arcuate Ligament Syndrome

Rawala

Ahmed

Rizvi

2020

Cureus

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

An Atypical Presentation of Median Arcuate Ligament Syndrome

Rawala

Ahmed

Rizvi

2020

Cureus

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“…Asymptomatic compression or stenosis of the CT is common, probably due to hemodynamic compensation mechanisms: autopsy studies have shown that the CT is compressed by the MAL in up to one-third of individuals [1]. Vascular and neurologic theories have been suggested to elucidate the symptomatic cases of MALS [4]. Compression of the CT by MAL causes mesenteric ischemia, with abdominal angina if the arterial blood flow is reduced from 60-75%, because there is an extensive collateral blood supply to the mesenterium from other blood vessels (superior and inferior mesenteric artery).…”

Section: Discussionmentioning

confidence: 99%

Mini-invasive treatment of median arcuate ligament syndrome, a case report

Luca¹,

Mazza²

2019

SCR

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Introduction: Median arcuate ligament syndrome (MALS), also known as Dunbar syndrome or celiac artery compression syndrome, is a rare disorder due to external compression of the celiac trunk (CT) by the median arcuate ligament (MAL). The diagnosis is difficult and often one of exclusion, because of its nonspecific symptoms that overlap with other forms of chronic intestinal ischemia. Laparoscopic approach is considered to be an optimal therapeutic option. Material and Surgical Techniques: We describe the case of a 40-year-old woman who presented with a 4 years-long clinical history of postprandial abdominal pain, occasional vomiting and severe weight loss in the last year. An abdominal CT scan demonstrated an external compression of the CT and the patient underwent laparoscopic decompression by division of the MAL. Postoperative course was uneventful and the patient was discharged on the 5th postoperative day. Discussion: Despite being MALS a rare disease, it must be kept in the differential diagnosis of abdominal pain. Diagnosis is difficult and often requires 2nd level investigations. Laparoscopy can be useful both as a diagnostic and curative approach. The laparoscopic division of the MAL is a feasible and safe procedure, leading to an improved quality of life

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“…There are few studies done in past, where 75 fresh autopsy specimens were studied and analyzed relative to the relationship between the MAL and the celiac artery, the celiac plexus, and the inferior phrenic arteries. The following observations were made: (1) celiac ganglionic cuirass often participates in arterial compression, (2) celiac artery origin was at or above the median arcuate ligament in up to 25 (33%), (3) this was due to a low ligament rather than a high artery [13]. In another study, 46 cadaveric specimens were dissected to study the anatomical relations between the MAL, the celiac ganglion, and the origin of both the celiac and superior mesenteric arteries.…”

Section: Discussionmentioning

confidence: 99%

“…MALS is an uncommon entity but it should be kept in mind in the presence of unexplained gastrointestinal symptoms. CT abdomen is minimally invasive and plays a dominant role in the diagnosis of MAL compression [3].…”

Section: Introductionmentioning

confidence: 99%

A Study of Incidental Findings of Median Arcuate Ligament Syndrome Detected on Emergency Computed Tomography of Abdomen

Pattanshetti¹,

Pattanshetti²,

Patil³

et al. 2016

IJAR

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Introduction:The use of computed tomography (CT) has substantially increased in the emergency setting due to its better availability. Consequently, with increased and frequent use of CT there has been a rise in detection of number of incidental pathologies including congenital anomalies or variations. Median Arcuate Ligament Syndrome (MALS) is one such entity detected majority of the times incidentally on CT abdomen. The purpose of our study is to know the incidental finding of MALS in our University teaching hospital. Methods and Results:A retrospective review of all emergency CT abdominal scans done during the year 2015 at KLES Dr Prabhakar Kore Hospital and MRC, Belagavi was examined. There were total 135 patients who had an emergency abdominal CT scan of which 76 (56%) had some definitive pathology which can be clinically correlated with the history of patient.18 (13%) incidental findings detected, of which 4 (3%) were deemed to have MALS. Out of 4 MALS cases 2 cases were associated with other abdominal pathologies. One case was associated with pancreatitis and another case was associated with intramural hemorrhage of jejunum. Conclusion:Sometimes MALS can be associated with other abdominal pathology as detected in our study and reporting of such association will be more helpful to treating surgeons and clinicians. There is a need for larger clinico-radiological and anatomic cadaveric dissection type of studies to know the incidence of MALS in general population.

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Compression of the Celiac Artery by the Median Arcuate Ligament: Multidetector Computed Tomography Findings and Characteristics

Abstract: MALS is an uncommon entity but it should be kept in mind in the presence of unexplained gastrointestinal symptoms. MDCT is a minimally invasive and plays a dominant role in the diagnosis of MAL compression especially with reformatted and 3-D reconstructed images.

Cited by 30 publications

References 17 publications

An Atypical Presentation of Median Arcuate Ligament Syndrome

An Atypical Presentation of Median Arcuate Ligament Syndrome

Mini-invasive treatment of median arcuate ligament syndrome, a case report

A Study of Incidental Findings of Median Arcuate Ligament Syndrome Detected on Emergency Computed Tomography of Abdomen

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