Median arcuate ligament syndrome (MALS), is a rare abdominal vascular compression syndrome caused by the compression of the proximal celiac trunk by the median arcuate ligament. According to many authors, a low insertion of the diaphragmatic crura or an abnormally high origin of the celiac trunk from the aorta can cause compression of the celiac artery. Usually, patients with MALS are asymptomatic. Computed tomography (CT) angiography of the abdomen is the main imaging modality to confirm the diagnosis. The coexistence of celiac trunk and superior mesenteric artery compression by the median arcuate ligament is rarely described in the literature. To our knowledge, until now, a simultaneous combination of three abdominal vascular compressions by the median arcuate ligament has never been described. From this case, we report a simultaneous compression of the celiac trunk, superior mesenteric artery, and renal arteries by the median arcuate ligament.
References
[1]
Harjola, P.T. (1963) A Rare Obstruction of the Coeliac Artery. Annales chirurgiae et gynaecologiaeFenniae, 52, 547-550.
[2]
Rubinkiewicz, M., Ramakrishnan, P., Henry, B., Roy, J. and Budzyski, A. (2015) Laparoscopic Decompression as Treatment for Median Arcuate Ligament Syndrome. The Annals of the Royal College of Surgeons of England, 97, e96-e99. https://doi.org/10.1308/rcsann.2015.0025
[3]
Lindner, H.H. (1971) A Clinicoanatomical Study of the Arcuate Ligament of the Diaphragm. Archives of Surgery, 103, 600-605. https://doi.org/10.1001/archsurg.1971.01350110102016
[4]
Rodriguez, J.H. (2021) Median Arcuate Ligament Syndrome: A Clinical Dilemma. Cleveland Clinic Journal of Medicine, 88, 143-144. https://doi.org/10.3949/ccjm.88a.21001
[5]
Curl, J.H., Thompson, N.W. and Stanley, J.C. (1971) Median Arcuate Ligament Compression of the Celiac and Superior Mesenteric Arteries. Annals of Surgery, 173, 314-320. https://doi.org/10.1097/00000658-197102000-00022
[6]
Dunbar, J.D., Molnar, W., Beman, F.F. and Marable, S.A. (1965) Compression of the Celiac Trunk and Abdominal Angina. American Journal of Roentgenology, 95, 731-744. https://doi.org/10.2214/ajr.95.3.731
[7]
Saleem, T., Katta, S. and Baril, D.T. (2023) Celiac Artery Compression Syndrome. StatPearls.
[8]
Reilly, L.M., Ammar, A.D., Stoney, R.J. and Ehrenfeld, W.K. (1985) Late Results Following Operative Repair for Celiac Artery Compression Syndrome. Journal of Vascular Surgery, 2, 79-91. https://doi.org/10.1016/0741-5214(85)90177-6
[9]
Stein, J.J., Costanza, M.J., Rivero, M., Gahtan, V. and Amankwah, K.S. (2011) External Compression of the Superior Mesenteric Artery by the Median Arcuate Ligament. Vascular and Endovascular Surgery, 45, 565-567. https://doi.org/10.1177/1538574411412827
[10]
Farina, R., Gozzo, C., Foti, P.V., Conti, A., Vasile, T., Pennisi, I., Venturini, M. and Basile, A. (2021) A Man with the Rare Simultaneous Combination of Three Abdominal Vascular Compression Syndromes: Median Arcuate Ligament Syndrome, Superior Mesenteric Artery Syndrome, and Nutcracker Syndrome. Radiology Case Reports, 16, 1264-1270. https://doi.org/10.1016/j.radcr.2021.02.065
[11]
Wu, E. (2018) Median Arcuate Ligament Syndrome. Journal of Diagnostic Medical Sonography, 35, 141-145. https://doi.org/10.1177/8756479318818061
[12]
Horton, K.M., Talamini, M.A. and Fishman, E.K. (2005) Median Arcuate Ligament Syndrome: Evaluation with CT Angiography. RadioGraphics, 25, 1177-1182. https://doi.org/10.1148/rg.255055001
[13]
Ozel, A., Toksoy, G., Ozdogan, O., et al. (2012) Ultrasonographic Diagnosis of Median Arcuate Ligament Syndrome: A Report of Two Cases. Medical Ultrasonography, 14, 154-157.
[14]
Narwani, P., Khanna, N., Rajendran, I., Kaawan, H. and Al-Sam, R. (2021) Median Arcuate Ligament Syndrome Diagnosis on Computed Tomography: What a Radiologist Needs to Know. Radiology Case Reports, 16, 3614-3617. https://doi.org/10.1016/j.radcr.2021.06.093
[15]
Mensink, P.B., van Petersen, A.S., Kolkman, J.J., Otte, J.A., Huisman, A.B. and Geelkerken, R.H. (2006) Gastric Exercise Tonometry: The Key Investigation in Patients with Suspected Celiac Artery Compression Syndrome. Journal of Vascular Surgery, 44, 277-281. https://doi.org/10.1016/j.jvs.2006.03.038
[16]
Jimenez, J.C., Harlander-Locke, M. and Dutson, E.P. (2012) Open and Laparoscopic Treatment of Median Arcuate Ligament Syndrome. Journal of Vascular Surgery, 56, 869-873. https://doi.org/10.1016/j.jvs.2012.04.057
[17]
Scharf, M., Thomas, K.A., Sundaram, N., Ravi, S.J. and Aman, M. (2021) Median Arcuate Ligament Syndrome Masquerading as Functional Abdominal Pain Syndrome. Cureus, 13, e20573. https://doi.org/10.7759/cureus.20573
[18]
Fernstrum, C., Pryor, M., Wright, G.P. and Wolf, A.M. (2020) Robotic Surgery for Median Arcuate Ligament Syndrome. JSLS: JournaloftheSocietyofLaparoscopic&RoboticSurgeons, 24, e2020.00014. https://doi.org/10.4293/jsls.2020.00014
[19]
Iqbal, S. and Chaudhary, M. (2021) Median Arcuate Ligament Syndrome (Dunbar Syndrome). CardiovascularDiagnosisandTherapy, 11, 1172-1176. https://doi.org/10.21037/cdt-20-846
