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Case Reports
. 2022 Sep 7;14(9):e28889.
doi: 10.7759/cureus.28889. eCollection 2022 Sep.

Median Arcuate Ligament Syndrome: Management and Literature Review

Okelue E Okobi  1 , Belinda A Afuda  2 , Maureen Boms  3 , Chinwendum U Ekpemiro  4 , Nneka J Umeh  5 , Chukwudike G Nnaji  6 , Nkemputaife P Onyechi  7 , Oluwatobi G Faderin  8 , Jennifer C Chiji-Aguma  9 , Eboigbe Stephen  10 , Clifford O Amadi  11
Affiliations
Case Reports

Median Arcuate Ligament Syndrome: Management and Literature Review

Okelue E Okobi et al. Cureus. .

Abstract

Pain, nausea, vomiting, weight loss, diarrhea, and fatigue are common symptoms of several upper gastroenterological illnesses. However, the presence of unexplained recurring postprandial abdominal pain and vomiting increases the possibility of median arcuate ligament syndrome (MALS). MALS is an uncommon illness characterized by postprandial vomiting, abdominal pain, and weight loss. The compression of the median arcuate ligament on the celiac trunk and/or its surrounding celiac nerve plexus may explain this disease phenomenon. Comprehensive workup for other etiologies may be unrevealing except for the compression of the celiac trunk identified in imaging studies and, perhaps, occasional arterial flow rates in sonography studies in some severe cases. Due to the overlapping symptoms of upper gastroenterological disorders, misdiagnosis may be widespread. Therefore, it is essential to consider MALS while examining a patient with upper gastrointestinal disease. In this case series, we present two cases of MALS with similar clinical trajectories and differences in diagnostic techniques.

Keywords: celiac axis compression syndrome; median arcuate ligament release; median arcuate ligament syndrome; nausea; persistent vomiting; postprandial vomiting; recurrent upper abdominal pain; recurrent vomiting; unexplained abdominal pain; weight loss.

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Conflict of interest statement

The authors have declared that no competing interests exist.

Figures

Figure 1
Figure 1. Doppler Ultrasound with the arrow showing the point at the constriction of the different variations of flow through the celiac trunk.
A: constricted portion of the celiac artery. B: supine expiration. C: erect expiration. D: erect inspiration.
Figure 2
Figure 2. MRA showing the site of compression with pre- and post-ballooning of the celiac trunk.
MRA: magnetic resonance angiography
Figure 3
Figure 3. CTA showing compression of the celiac trunk as indicated by the arrow.
CTA: computed tomography angiogram
Figure 4
Figure 4. Artistic illustration or pre- and post-MAL release.
This illustration is the creation of the authors’ imaginations, depicting anatomical connections between the celiac trunk and the MAL both pre and postoperatively. MAL: median arcuate ligament
See this image and copyright information in PMC

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