Open and laparoscopic treatment of median arcuate ligament syndrome

Jiménez, Juan Carlos; Harlander-Locke, Michael P.; Dutson, Erik

doi:10.1016/j.jvs.2012.04.057

Cited by 176 publications

(191 citation statements)

References 20 publications

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“…In our patients, postprandial abdominal pain was the most prominent symptom, consistent with the findings by Jimenez et al, where the most commonly reported symptom in 80% of patients was abdominal pain. 6 No abdominal bruits were discernible on auscultation in either of our patients. Several previous cases have reported the transient relief of symptoms with MALS when the patients bring their knees up to their chest.…”

Section: Case Bmentioning

confidence: 46%

Laparoscopic decompression as treatment for median arcuate ligament syndrome

Rubinkiewicz

Ramakrishnan

Henry

et al. 2015

annals

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Median arcuate ligament syndrome (MALS) is a rare disorder due to coeliac trunk compression by the median arcuate ligament, resulting in coeliac artery stenosis characterised by chronic, recurrent abdominal pain. Patients with MALS are often middleaged females presenting with a triad of postprandial epigastric pain, weight loss and abdominal bruit. It is a diagnosis of exclusion and confirmed by computed tomography or magnetic resonance imaging. Laparoscopic or open surgical decompression are the only treatment options in MALS. We present two cases of MALS treated by laparoscopic decompression as well as a literature review on this treatment. Median arcuate ligament syndrome (MALS), also known as coeliac artery compression syndrome or Dunbar syndrome, is a rare phenomenon due to coeliac trunk compression by the median arcuate ligament (MAL). The ligament, which lies superior to the coeliac artery, is a fibrous arch connecting the crura of the diaphragm forming the aortic hiatus. An abnormally low lying ligament can cause coeliac artery stenosis, potentially resulting in chronic, recurrent abdominal pain. Diagnosis is challenging and only confirmed after exclusion of other causes of abdominal pain. Surgical treatment is the only option in MALS. While open decompression has been the traditional approach, laparoscopic decompression is an emerging therapy. We present two cases of MALS treated with laparoscopic decompression. Case histories Case AA 31-year-old woman presented with several episodes of chest pain, palpitations, exercise intolerance, nausea, vertigo, tremors and hypertension. She had a history of chronic and recurrent abdominal pain, especially after meals. Gastrointestinal tract pathologies were ruled out by ultrasonography, gastroscopy and colonoscopy. Abdominal computed tomography (CT) revealed high grade stenosis (>80%) of the coeliac artery, 10mm from its origin from the aorta (Figs 1 and 2). The patient was subsequently diagnosed with MALS and admitted to our department for surgical treatment. Case BA 26-year-old woman was admitted to a local hospital owing to worsening chronic abdominal pain exacerbated after eating, and accompanied by nausea and vomiting. Ultrasonography found significant variations in the blood flow velocity of the coeliac artery during maximum inspiration and quiet respiration. Abdominal CT was ordered and the diagnosis of MALS with 70% stenosis was made. The patient was referred to our clinic for surgical treatment.In both cases, decompression of the coeliac trunk was performed using a laparoscopic approach. Prophylactic, intraoperative antibiotics and postoperative thromboembolytics were administered to the patients. During the surgery, the patients were placed in a supine split-leg reverse Trendelenburg position. Four ports were introduced (Figure 3). The technical access during surgery was achieved using an antegrade dissection method (Figure 4).The gastrohepatic ligament was divided to facilitate the identification of the right crus of the diaphragm, inferior to t...

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Section: Case Bmentioning

confidence: 46%

Laparoscopic decompression as treatment for median arcuate ligament syndrome

Rubinkiewicz

Ramakrishnan

Henry

et al. 2015

annals

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“…Both procedures are safe and effective. No death has been reported as a postoperative complication and the percentage of patients with immediate symptomatic relief is 85% [17].…”

Section: Treatmentmentioning

confidence: 99%

“…Other examinations leading to diagnosis are: MR, Doppler ultrasound evaluating blood flow velocity in the celiac artery, and arteriography which is becoming less popular due to its invasive nature. Each of these examinations should be performed both during inspiration and expiration, as the largest compression of the median arcuate ligament occurs during deep expiration but is not always visible during the inspiration phase [17].…”

Section: Diagnosismentioning

confidence: 99%

Celiac artery compression syndrome. Mini-review

Rongies-Kosmol

Jakimowicz

2015

Acta Angiologica

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“…Common symptoms of patients with MALS include weight loss, postprandial abdominal pain, nausea, and vomiting. According to a systemic review on MALS, 80% of patients present with abdominal pain and up to 48% of patients experience weight loss [11]. The physical exam is usually unremarkable other than the objective weight loss and an epigastric bruit that has been reported in 35% of patients with MALS [11].…”

Section: Clinical Evaluationmentioning

confidence: 99%

“…According to a systemic review on MALS, 80% of patients present with abdominal pain and up to 48% of patients experience weight loss [11]. The physical exam is usually unremarkable other than the objective weight loss and an epigastric bruit that has been reported in 35% of patients with MALS [11]. A thorough investigation of common etiologies of abdominal pain and weight loss should be performed (Table 1), prior to diagnosing MALS.…”

Section: Clinical Evaluationmentioning

confidence: 99%

Median Arcuate Ligament Syndrome: An Unusual Cause of Chronic Abdominal Pain

Kallus

Singhal²,

Palese³

et al. 2016

Neuroenterology

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Chronic abdominal pain is one of the most frequent complaints of subjects visiting the gastroenterologist office and a large majority of these subjects have irritable bowel syndrome (IBS). Median arcuate ligament syndrome (MALS) is a rare cause of chronic abdominal pain that results from compression or ischemia of the celiac artery by the median arcuate ligament. Characteristic features include weight loss and postprandial pain, and the diagnosis can be confirmed by radiographic imaging. Surgical treatment can be curative. MALS is a diagnosis of exclusion and requires a high level of suspicion. Herein we present three unique cases of patients with chronic abdominal pain discovered to have MALS and we review the literature.

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Open and laparoscopic treatment of median arcuate ligament syndrome

Cited by 176 publications

References 20 publications

Laparoscopic decompression as treatment for median arcuate ligament syndrome

Laparoscopic decompression as treatment for median arcuate ligament syndrome

Celiac artery compression syndrome. Mini-review

Median Arcuate Ligament Syndrome: An Unusual Cause of Chronic Abdominal Pain

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