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

Authors

  • Ji Chen Department of Upper Gastrointestinal Surgery, The Wollongong Hospital, Sydney, Australia http://orcid.org/0000-0002-4008-7716
  • Anik Sarkar Department of Upper Gastrointestinal Surgery, The Wollongong Hospital, Sydney, Australia
  • Mouhannad Jaber Department of Upper Gastrointestinal Surgery, The Wollongong Hospital, Sydney, Australia

DOI:

https://doi.org/10.18203/2349-2902.isj20214016

Keywords:

Median, Arcuate, Ligament, Coeliac, Dunbar, Algorithm

Abstract

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.

References

Loukas M, Pinyard J, Vaid S, Kinsella C, Tariq A, Tubbs RS. Clinical anatomy of celiac artery compression syndrome: a review. Clin Anat. 2007;20(6):612-7.

Horton KM, Talamini MA, Fishman EK. Median arcuate ligament syndrome: evaluation with CT angiography. Radiographics. 2005;25(5):1177-82.

Park CM, Chung JW, Kim HB, Shin SJ, Park JH. Celiac axis stenosis: incidence and etiologies in asymptomatic individuals. Korean J Radiol. 2001;2(1):8-13.

Weber JM, Boules M, Fong K, Abraham B, Bena J, Hayek K, et al. Median Arcuate Ligament Syndrome Is Not a Vascular Disease. Ann Vasc Surg. 2016;30:22-7.

Aschenbach R, Basche S, Vogl TJ. Compression of the celiac trunk caused by median arcuate ligament in children and adolescent subjects: evaluation with contrast-enhanced MR angiography and comparison with Doppler US evaluation. J Vasc Interv Radiol. 2011;22(4):556-61.

Gruber H, Loizides A, Peer S, Gruber I. Ultrasound of the median arcuate ligament syndrome: a new approach to diagnosis. Med Ultrason. 2012;14(1):5-9.

Jimenez JC, Locke M, Dutson EP. Open and laparoscopic treatment of median arcuate ligament syndrome. J Vasc Surg. 2012;56(3):869-73.

Ath HD, Wong S, Szentpali K, Somers S, Peck T, Wakefield CH. The Laparoscopic Management of Median Arcuate Ligament Syndrome and Its Long-Term Outcomes. J Laparoendosc Adv Surg Tech A. 2018;28(11):1359-63.

Cienfuegos JA, Estevez MG, Canela M, Pardo F, Caballero A, Vivas I, Bilbao JI, et al. Laparoscopic Treatment of Median Arcuate Ligament Syndrome: Analysis of Long-Term Outcomes and Predictive Factors. J Gastrointest Surg. 2018;22(4):713-21.

Fernstrum C, Pryor M, Wright GP, Wolf AM. Robotic Surgery for Median Arcuate Ligament Syndrome. JSLS. 2020;24(2):00014.

Khrucharoen U, Juo YY, Chen Y, Jimenez JC, Dutson EP. Short- and intermediate-term clinical outcome comparison between laparoscopic and robotic-assisted median arcuate ligament release. J Robot Surg. 2020;14(1):123-9.

Columbo JA, Trus T, Nolan B, Goodney P, Rzucidlo E, Powell R, et al. Contemporary management of median arcuate ligament syndrome provides early symptom improvement. J Vasc Surg. 2015;62(1):151-6.

Downloads

Published

2021-09-28

Issue

Section

Case Reports