Laparoscopic decompression as treatment for median arcuate ligament syndrome

Abstract

Median arcuate ligament syndrome (MALS) is a rare disorder due to coeliac trunk compression by the median arcuate ligament, resulting in coeliac artery stenosis characterised by chronic, recurrent abdominal pain. Patients with MALS are often middle-aged females presenting with a triad of postprandial epigastric pain, weight loss and abdominal bruit. It is a diagnosis of exclusion and confirmed by computed tomography or magnetic resonance imaging. Laparoscopic or open surgical decompression are the only treatment options in MALS. We present two cases of MALS treated by laparoscopic decompression as well as a literature review on this treatment.

Keywords: Coeliac artery compression syndrome; Dunbar syndrome; Laparoscopic decompression; Median arcuate ligament syndrome.

Figure 1

Computed tomography showing compression of coeliac trunk by the median arcuate ligament with poststenotic dilation (arrow)

Figure 2

Three-dimensional computed tomography reconstruction showing anterior (A) and lateral (B) views of compression of coeliac trunk by the median arcuate ligament with poststenotic dilation (arrow)

Figure 3

Schematic diagram of the abdomen with trocar placement: 1 = 10mm optic; 2 and 3 = 5mm for grasper and scissors/coagulating hook of the operator; 4 = fan retractor

Figure 4

Surgical images: locating the MAL (A), cross-clamping the MAL with the ligation device (B), dividing the fibres of the MAL (C) and decompression of the coeliac trunk (D)