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Case Reports
. 2011 Oct 28:2011:bcr0820114572.
doi: 10.1136/bcr.08.2011.4572.

A rare cause of abdominal angina

Gian Piero Carboni  1 , Silvia Visconti, Sofia Battisti, Bruno Beomonte Zobel
Affiliations
Case Reports

A rare cause of abdominal angina

Gian Piero Carboni et al. BMJ Case Rep. .

Abstract

The authors report a case of a young male with median arcuate ligament syndrome (MALS). An abnormally low insertion of the median arcuate ligament fibres caused extrinsic compression and stenosis of the coeliac trunk. However, partial dissection of ligament fibres by laparoscopic surgery did not relieve abdominal angina. Multidetector CT confirmed that MALS did not differ from the preoperative scan. The arcuate ligament compressed the coeliac trunk on expiration, thereby eliciting occlusion of the coeliac trunk. Inspiration induced decompression of the ligament with partial release of occlusion of the coeliac trunk. This leads to hypo-perfusion of intestinal organs and abdominal angina. Considering the severe impairment of quality of life, open surgery for decompression of the coeliac trunk with vascular reconstruction is a reasonable option.

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Conflict of interest statement

Competing interests None.

Figures

Figure 1
Figure 1
MDCT sagittal three-dimensional volume-rendered images. (A) Occlusion of the coeliac trunk with a ‘hook-like’ appearance on expiration (white arrow). (B) Release of occlusion of the coeliac trunk during inspiration (blue arrow); poststenosis dilation (red arrow).
Figure 2
Figure 2
MDCT coronal three-dimensional volume-rendered images. Dilated gastroduodenal artery (red arrow) and splenic artery (green arrow). The gastroduodenal artery is a subdivision of the common hepatic artery and a branch of the coeliac trunk. The splenic artery is a branch of the coeliac trunk (yellow arrow). The calibre of these arteries appears to be increased by more than two-thirds when compared with that of normal patients.
See this image and copyright information in PMC

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