Srpski arhiv za celokupno lekarstvo 2015 Volume 143, Issue 1-2, Pages: 74-78
https://doi.org/10.2298/SARH1502074K
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Cited by
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