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Srpski arhiv za celokupno lekarstvo 2015 Volume 143, Issue 1-2, Pages: 74-78
https://doi.org/10.2298/SARH1502074K
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Surgical treatment of median arcuate ligament syndrome: Case report and review of literature

Kotarac Milutin (Clinical Center of Serbia, First Surgical Clinic, Clinic for Digestive Surgery, Belgrade)
Radovanović Nebojša (Clinical Center of Serbia, First Surgical Clinic, Clinic for Digestive Surgery, Belgrade + School of Medicine, Belgrade)
Lekić Nebojša (Clinical Center of Serbia, First Surgical Clinic, Clinic for Digestive Surgery, Belgrade)
Ražnatović Zoran (Clinical Center of Serbia, First Surgical Clinic, Clinic for Digestive Surgery, Belgrade)
Đorđević Vladimir (Clinical Center of Serbia, First Surgical Clinic, Clinic for Digestive Surgery, Belgrade)
Lekić Dragana (Institute for Mother and Child Health Care of Serbia “Dr Vukan Čupić”, Belgrade)
Sagić Dragan (School of Medicine, Belgrade + Institute for Cardiovascular Diseases "Dedinje", Belgrade)

Introduction. Median arcuate ligament (MAL) syndrome, also called celiac trunk compression syndrome (CACS) or Dunbar syndrome is a rare disorder caused by compression of the celiac artery by median arcuate ligament of the diaphragm, which leads to mesenteric ischemia and chronic abdominal angina. The typical clinical triad of symptoms includes postprandial epigastric pain, weight loss and vomiting. The gold standard for MAL syndrome diagnosis is selective angiography, while in symptomatic patients with angiographically verified stenosis the optimal therapy is surgical treatment. Case Outline. A 40-year-old male patient was presented with epigastric pain, followed by dyspepsia and weight loss. The upper endoscopy showed gastric and duodenal distention with prominent folds of gastric mucosa and slow peristalsis. Selective angiography showed stenosis (90%) of initial segment of the celiac trunk. Adhesiolysis with the transection of the median arcuate ligament was performed. Due to repeated symptoms, the patient was reoperated on the 10th postoperative day with performed adhesiolysis and gastrostomy for gastric nutrition. Two months later, the patient was rehospitalized for closure of gastrostomy. At five years follow-up, selective angiography showed no stenosis of the initial segment of the celiac artery. Conclusion. Despite the existing controversy concerning pathophysiological mechanism, the clinical presentation and treatment modalities of patients with MAL syndrome, it is evident that careful selection and adequate surgical treatment may significantly reduce symptoms in these patients.

Keywords: celiac artery, median arcuate ligament, diaphragm, arterial occulsive disease