Median arcuate ligament syndrome

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Obesity, Sleep & Internal medicine
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Median arcuate ligament syndrome
Diagram of the celiac artery and its branches
Synonyms	Celiac artery compression syndrome, Dunbar syndrome
Pronounce	N/A
Specialty	Vascular surgery
Symptoms	Abdominal pain, weight loss, nausea, vomiting
Complications	N/A
Onset	Typically young adults
Duration	Chronic
Types	N/A
Causes	Compression of the celiac artery by the median arcuate ligament
Risks	Anatomical variation
Diagnosis	CT angiography, Doppler ultrasound, MRI
Differential diagnosis	Chronic mesenteric ischemia, peptic ulcer disease, gastroesophageal reflux disease
Prevention	N/A
Treatment	Surgical decompression, celiac artery revascularization
Medication	N/A
Prognosis	Generally good with treatment
Frequency	Rare
Deaths	N/A

Median Arcuate Ligament Syndrome (MALS), also known as Celiac Artery Compression Syndrome, is a rare condition characterized by chronic abdominal pain due to the compression of the celiac artery by the median arcuate ligament. This ligament is a fibrous band that connects the diaphragmatic crura on either side of the aortic hiatus.

Anatomy and Pathophysiology

The median arcuate ligament is part of the diaphragm, a major muscle involved in respiration. In MALS, the ligament compresses the celiac artery, which supplies blood to the upper abdominal organs, including the stomach, liver, spleen, and pancreas. This compression can lead to reduced blood flow (ischemia) and cause symptoms.

Symptoms

The primary symptom of MALS is chronic abdominal pain, which is often described as a dull, aching pain in the upper abdomen. Other symptoms may include:

• Nausea
• Vomiting
• Weight loss
• Diarrhea
• Bloating

Diagnosis

Diagnosing MALS can be challenging due to its nonspecific symptoms. Diagnostic methods include:

• Doppler ultrasound to assess blood flow in the celiac artery.
• Computed tomography angiography (CTA) or magnetic resonance angiography (MRA) to visualize the compression.
• Celiac plexus block to determine if pain relief occurs, indicating the celiac artery as the pain source.

Treatment

Treatment options for MALS include:

• Surgical intervention: The most common treatment is the surgical release of the median arcuate ligament to relieve the compression on the celiac artery.
• Endovascular procedures: In some cases, angioplasty or stenting of the celiac artery may be performed.

Prognosis

The prognosis for patients with MALS varies. Many patients experience significant pain relief following surgical intervention, although some may continue to have symptoms.

See also

• Celiac artery
• Diaphragm (anatomy)
• Ischemia
• Abdominal pain