Pediatric Chronic Abdominal Pain and Median Arcuate Ligament Syndrome: A Review and Psychosocial Comparison

Abstract

Chronic abdominal pain (CAP) occurs in children and adolescents with a reported prevalence of 4% to 41% with significant direct and indirect costs to the child, family, and society. Median arcuate ligament syndrome (MALS) is a vascular compression syndrome of the celiac artery that may cause symptoms of epigastric pain and weight loss and is a frequently overlooked cause of CAP in the pediatric population. We have observed that the psychosocial presentation of patients with MALS is notable for various psychiatric comorbidities. In this article, we review MALS as well as our study results of the psychosocial profile of 30 MALS patients. Our data suggest that children and adolescents with MALS have similar psychosocial profiles to children with other gastrointestinal disorders resulting in CAP. The overlap of physical and psychosocial symptoms of patients who have MALS with other CAP disorders leads us to recommend that patients with CAP should be evaluated for MALS. [Pediatr Ann. 2016;45(7):e257-e264.].

The impact of psychiatric comorbidities on patient-reported surgical outcomes in adults treated for the median arcuate ligament syndrome

“…In a separate cohort of 30 children (<18 years old) with MALS, 43% (n ¼ 13) demonstrated symptoms consistent with a psychiatric disorder. 18,19 To add to this complex picture, pediatric patients with MALS have psychological profiles (eg, a high incidence of anxiety and mood disorders) comparable to those of patients with other gastrointestinal disorders resulting in chronic abdominal pain (eg, inflammatory bowel disease). 19 Functional gastrointestinal disorders resulting in chronic abdominal pain ensue from a complex interplay of biologic, psychological, and social factors.…”

“…18,19 To add to this complex picture, pediatric patients with MALS have psychological profiles (eg, a high incidence of anxiety and mood disorders) comparable to those of patients with other gastrointestinal disorders resulting in chronic abdominal pain (eg, inflammatory bowel disease). 19 Functional gastrointestinal disorders resulting in chronic abdominal pain ensue from a complex interplay of biologic, psychological, and social factors. 20 It is these factors that add to the complexity of treating patients with MALS.…”

Endoscopic full-thickness biopsy, a novel method in the work up of complicated abdominal symptoms

“…The patients may be misdiagnosed due to overlap of physical and psychosocial symptoms with other gastrointestinal diseases, for example, IBS. 4 The treatment of MALS is surgery to relieve the extrinsic compression. Nevertheless, a great number of patients undergoing surgery are not relieved of their symptoms.…”

Hybrid (laparoscopy + stent) treatment of celiac trunk compression syndrome (Dunbar syndrome, median arcuate ligament syndrome (MALS)).

“…It was first described by J.D. Dunbar in 1965 [ 1 , 2 ]. Median arcuate ligament syndrome (MALS) usually affects young people (20–40 years old), thin, often women.…”

“…As a result of this condition intestinal ischemia occurs, which in 80% of people causes symptoms of abdominal angina (AA) – abdominal pain occurring after ingestion of food. However, 20% of cases are asymptomatic [ 2 , 3 ]. Nutritional disorders can result in weight loss in a relatively short time.…”