Median Arcuate Ligament Syndrome (Mals): A Case Report of a Young Patient [Conference Winner Abstract]

Abstract

Introduction Median arcuate ligament syndrome (MALS) is a celiac artery compression syndrome. It is a rare phenomenon caused by compression of the celiac trunk by median arcuate ligament. Fibers insert inferiorly and cross anteriorly to the celiac trunk with the compression of the artery. [1] Laparoscopic median arcuate ligament release and transection of the celiac plexus is the "gold" standard for treating MALS. [3] Case Presentation A 40-year-old female with no comorbidities presented to her primary physician complaining of chronic abdominal pain, appetite loss, pain after eating, decline in weight about 5 years. The symptoms have caused her to reduce her food intake and skip meals entirely. Also reported nausea, vomiting after eating during abdominal pain episode. The patient was referred to general surgery in outpatient clinic for further evaluation and management. Abdomen CT with intravenous contrast was performed and found short segment stenosis of the coeliac trunk with a characteristic hooked appearance, post-stenotic dilatation, and the thickening of the median arcuate ligament. The abdomen/pelvis CTA was done and found 50% celiac artery stenosis. Due to inadequate symptom control, laparoscopic median arcuate ligament release was performed in one month after the first visit to general surgeon. After the surgery all symptoms subsided. Discussion It is calculated that the incidence of MALS has been estimated to be about 2/100,000 patients per year. [3] There are no uniform diagnostic criteria for MALS, but the diagnosis requires ruling out other etiologies. Complications of MALS includes gastroparesis and pancreatic duodenal aneurysm, etc. [2] Celiac artery decompression is indicated only for symptomatic patients with confirmed celiac artery compression on inspiratory and expiratory vascular imaging studies. [1] If symptoms persist even after laparoscopic ligament release, revascularization of the celiac artery by either endovascular stenting or bypass can be considered as secondary options. [4] Conclusions MALS is a rare and incompletely understood syndrome. We presented a case report of MALS. This case highlights the importance differential diagnosis for patients with chronic abdominal pain, weight loss. Laparoscopic median arcuate ligament release and transection of the celiac plexus is an effective treatment for MALS.