Median arcuate ligament syndrome and a laparoscopic coeliac trunk first approach: a literature review and a proposed algorithm


  • Ji Chen Department of Upper Gastrointestinal Surgery, The Wollongong Hospital, Sydney, Australia
  • Anik Sarkar Department of Upper Gastrointestinal Surgery, The Wollongong Hospital, Sydney, Australia
  • Mouhannad Jaber Department of Upper Gastrointestinal Surgery, The Wollongong Hospital, Sydney, Australia



Median, Arcuate, Ligament, Coeliac, Dunbar, Algorithm


Median arcuate ligament syndrome (MALS) is a rare condition where chronic recurrent abdominal pain is related to the compressive effects of the median arcuate ligament on the coeliac artery. The mechanism behind this phenomenon is incompletely understood but thought to be both ischemic and neuropathic in nature. As a result, the management of this condition remains controversial. Furthermore, while there have been a variety of options both radiological and interventional described for the investigation of MALS, there has yet to be a consensus in how patients exhibiting symptoms should be assessed and worked up. In this article, we described a laparoscopic coeliac trunk first approach in a young female patient and following review of the literature, propose an algorithm that can be used in the assessment and management of suspected MALS.


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