Median Arcuate Ligament Syndrome in a patient with Crohn's disease

Sturiale, Alessandro; Alemanno, Giovanni; Giudici, Francesco; Addasi, Rami; Bellucci, Francesco; Tonelli, Francesco

doi:10.1016/j.ijscr.2013.01.015

Cited by 13 publications

(18 citation statements)

References 13 publications

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“…This is one of three case reports discussing MALS in a patient with a previous diagnosis of inflammatory bowel disease [4,5]. While no known correlation currently exists, future studies should evaluate the risk of developing inflammatory bowel disease and other gastrointestinal disorders in patients diagnosed with MALS.…”

Section: Discussionmentioning

confidence: 93%

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Median Arcuate Ligament Syndrome: A Cause of Postprandial Abdominal Pain in a Patient With Ulcerative Colitis

Hill

2014

J Med Cases

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We report a case of a young woman with ulcerative colitis presenting with 6-month postprandial abdominal pain, nausea, vomiting and weight loss. After an extensive diagnostic workup confirming the presence of multiple other potential causes abdominal pain including ulcerative colitis, pancreatitis and primary sclerosing cholangitis (PSC), and then she was diagnosed with median arcuate ligament syndrome (MALS). Her pain was relieved after laparoscopic lysis of median arcuate ligament.

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Section: Discussionmentioning

confidence: 93%

“…MALS has been linked to the development of other gastrointestinal disorders such as gastroparesis [3]. Additionally a review of the literature revealed two case reports of MALS in patients with Crohn's disease [4,5]. We present a case of MALS in a young woman with ulcerative colitis.…”

Section: Introductionmentioning

confidence: 96%

Median Arcuate Ligament Syndrome: A Cause of Postprandial Abdominal Pain in a Patient With Ulcerative Colitis

Hill

2014

J Med Cases

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“…2 , 3 The symptoms derived could be explained by postprandial blood theft and an overstimulation of the coeliac plexus, resulting in vasoconstriction and ischaemia. 4 , 5 …”

Section: Discussionmentioning

confidence: 99%

Gastric ischaemia as an unusual presentation of median arcuate ligament compression syndrome

2017

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Median arcuate ligament compression syndrome is an anatomical and clinical entity defined by a combination of extrinsic compression of the coeliac axis by the median arcuate ligament and clinical manifestations. The majority of patients with features of compression experience no symptoms. The most common clinical symptoms when present are epigastric pain, nausea, vomiting and weight loss. Hypertrophy of the median arcuate ligament is a rare cause of chronic abdominal pain. We present a case of an elderly male patient who presented with acute epigastric pain, and gastric and intrahepatic portal pneumatosis on CT imaging. Emphysematous gastritis, caustic ingestion and other causes of this imaging presentation were ruled out. Imaging also showed chronic compression of the coeliac axis with compensatory hypertrophy of the gastroduodenal artery. Gastric ischaemia is a rare presentation of this syndrome, which occurs owing to the failure of compensatory mechanisms and resultant ischaemic injury to a virtual watershed vascular territory of the gastric wall. Conservative management was performed, including volume restoration, intravenous proton pump inhibitor therapy, broad-spectrum antibiotic therapy and blood transfusion. No surgical or endovascular interventional procedures were carried out. The patient showed clinical improvement soon after the initiation of treatment. Disappearance of the imaging findings was documented 2 weeks after treatment. Complete endoscopic recovery and absence of clinical alterations were observed during follow-up after 3 months.

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“…La angiografía sigue siendo el gold standard diagnóstico, la cual muestra la estenosis en el tronco celíaco, con dilatación post estenótica, pudiendo evidenciar un aumento de la estrechez en espira-ción 4 . La compresión extrínseca en SLAM produce alteraciones histológicas en el tronco celíaco, como hiperplasia intimal, proliferación de fibras elásticas y desorganización de la adventicia 8 , por lo que no es infrecuente que deban realizarse procedimientos endovasculares o plastías con parche del tronco celíaco 9 ; reservándose la reconstrucción vascular abierta, con bypass aortocelíaco -con vena safena o protésico-para los casos en que la sintomatología se mantiene tras el manejo endovascular, lográndose una mejoría sintomática en el 76% de los pacientes 2,3,8,9 . El abordaje laparoscópico ha sido reportado con buenos resultados, baja morbilidad y con menos del 15% de conversiones, con una regresión clínica de hasta el 86%, con más de un año de seguimiento, por lo que es una alternativa atractiva, sobre todo en el tratamiento de un abdomen no hostil 10,11 .…”

Section: Caso Clínicounclassified

“…Este ligamento discurre habitualmente por encima del origen del tronco celíaco 1 . Se cree que la compresión es originada por una inserción anormalmente baja del diafragma o un origen excesivamente alto del tronco celíaco en la aorta, pudiendo contribuir a la compresión fibras del ganglio celíaco [2][3][4] . Su incidencia es de 2/10 5 pacientes, presentándose más frecuentemente en mujeres de edad media, con baja de peso, dolor postprandial y soplo epigástrico; pero lo más frecuente es que sea un hallazgo, debido a que en la gran mayoría de los casos es asintomático (75-90%) 3,4 .…”

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Síndrome Ligamento Arcuato Medio

et al. 2015

Rev Chil Cir

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median arcuate ligament syndrome background: Median arcuate ligament syndrome (SLAM) is caused by extrinsic compression of the celiac artery by fibrous bands of this ligament and periaortic lymph node tissue. case report: We report a 59 years old man with a history of weight loss, epigastric pain and a postprandial murmur. The syndrome was diagnosed by CT angiography. The patient was operated, performing a midline laparotomy and releasing the extrinsic compression. An early and sustained remission of symptoms was achieved. resumen introducción: El síndrome del ligamento arcuato medio (SLAM), es causado por la compresión extrínseca del tronco celíaco por bandas fibrosas de este ligamento y tejido ganglionar periaórtico. caso clínico: Reportamos el caso de un hombre de 59 años con historia de baja de peso, dolor postprandial y soplo epigástrico, al cual se le diagnostica SLAM por medio de angioTC. Se realiza abordaje quirúrgico, con laparotomía media y liberación de la compresión extrínseca, logrando remisión de los síntomas de forma inmediata y sostenida. El SLAM es una causa infrecuente de dolor abdominal, requiere estudio por imágenes para su diagnóstico, la resolución quirúrgica constituye su tratamiento.Palabras clave: Síndrome ligamento arcuato medio, clínica, diagnóstico, tratamiento quirúrgico.

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Median Arcuate Ligament Syndrome in a patient with Crohn's disease

Abstract: This case demonstrates that the Median Arcuate Ligament Syndrome could be the major cause of symptoms, even in presence of other abdominal disorders.

Cited by 13 publications

References 13 publications

Median Arcuate Ligament Syndrome: A Cause of Postprandial Abdominal Pain in a Patient With Ulcerative Colitis

Median Arcuate Ligament Syndrome: A Cause of Postprandial Abdominal Pain in a Patient With Ulcerative Colitis

Gastric ischaemia as an unusual presentation of median arcuate ligament compression syndrome

Síndrome Ligamento Arcuato Medio

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