External Compression of the Superior Mesenteric Artery by the Median Arcuate Ligament

Abstract

The median arcuate ligament can compress the proximal portion of the celiac artery causing symptoms of chronic mesenteric ischemia. This rare condition typically affects young women and often poses a diagnostic challenge. Compression of the superior mesenteric artery (SMA) in addition to the celiac artery represents an unusual variant of median arcuate ligament syndrome (MALS). We present a case of MALS resulting predominantly from external compression of the SMA. Diagnostic and therapeutic options are discussed.

The influence of respiration on criteria for transabdominal duplex examination of the splanchnic arteries in patients with suspected chronic splanchnic ischemia

“…During endoscopic CA release, 22 we observed in a few patients that the muscle sling also wraps the SMA, explaining the increase in flow velocity during expiration in these patients. Stein et al 23 also described this in a case report.…”

Clinical and Radiologic Review of Uncommon Cause of Profound Iron Deficiency Anemia: Median Arcuate Ligament Syndrome

“…These symptoms are usually nonspecific and are easily misdiagnosed as functional dyspepsia, peptic ulcer disease, or gastropathy (1, 2, 3). But our patient showed that MALS might be a cause of recurrent abdominal pain associated with gastric ulcer and profound iron deficiency anemia that this association is relatively uncommon and therefore not well determined.…”

“…The character of the abdominal pain is often postprandial and associated with regurgitation of undigested food, and weight loss, all of which are caused by gastric ischemia from impingement of the celiac axis (1, 2, 3). But our patient showed that median arcuate ligament syndrome (MALS) might be a cause of recurrent abdominal pain associated with gastric ulcer and iron deficiency anemia that this association is relatively uncommon and therefore not well determined.…”

Multidetector Computed Tomographic Angiography for Optimal Cartography of the Visceral Abdominal Arterial Network: An Extensive Pictorial Review with Emphasis on Common and Uncommon Collateral Pathways, Complications and some Specific Syndromes

“…The Dunbar syndrome induced by the celiac trunk compression syndrome (CTCS) also called the median arcuate ligament syndrome (MALS) is a potential clinical entity characterized by a triad comprising epigastric pain, weight loss and postprandial pain with nausea and vomiting [ 5 6 7 8 9 10 ]. These symptoms are believed to be secondary to intermittent ischemia especially during the expiration phase [ 8 ].…”

“…Occasionally, in addition to the CTK the constricting effect of MAL may also manifest on the SMA and rarely on the renal arteries (RAs) [ 8 9 10 ]. If the compression on the SMA is important the development of the typical collaterals is compromised and the indirect and more distal substitution by of the IMA may be required (Figures 5 , 6 , 7 , 8 and 9 ).…”