Chronic Abdominal Pain, an Overlooked Diagnosis of Median Arcuate Ligament Syndrome (MALS)

Dafina Nikolova; Svetozar Antovic; Pance Karagjozov; Vilijam Kitevski; Meri Trajkovska; Magdalena G. Dimitrova; Gjorgji Deriban; Emilija Nikolovska Trpcevska; Ance Volkanovska Nikolovska

doi:10.2478/prilozi-2022-0009

Abstract

Median arcuate ligament syndrome (MALS) is a rare condition that is often overlooked as a result of its nonspecific symptoms. It is usually presented with nausea, bloating, abdominal postprandial pain, and weight loss. The diagnosis of MALS is usually delayed and made by excluding other causes for the symptoms. The diagnosis of this syndrome is based on clinical presentation and radiological findings on computer tomography angiography (CTA) or magnetic resonance angiography (MRA). Surgery is treatment of choice, with promising results from laparoscopic surgery.

References

1. Lainez RA, Richardson WS. Median Arcuate Ligament Syndrome: A Case Report. Ochsner J. 2013 Winter; 13(4): 561–564.
Search in Google Scholar Back to article
2. Becker E, Mohammed T, Wysocki J. Often Overlooked Diagnosis: Median Arcuate Ligament Syndrome as a Mimicker of Crohn’s Disease. ACG Case Rep J. 2021 Oct; 8(10): e00675.10.14309/crj.0000000000000675
Search in Google Scholar Back to article
3. Sturiale A, Alemanno G, Giudici F, Addasi R, Bellucci F, Tonelli F. Median arcuate ligament syndrome in a patient with Crohn’s disease. Int J Surg Case Rep. 2013; 4(4): 399–402.10.1016/j.ijscr.2013.01.015
Search in Google Scholar Back to article
4. You JS, Cooper M, Nishida S, Matsuda E, Murariu D. Treatment of Median Arcuate Ligament Syndrome via Traditional and Robotic Techniques. Hawaii J Med Public Health. 2013 Aug; 72(8): 279–281.
Search in Google Scholar Back to article
5. Sun Z, Zhang D, Hu G, Zhang N. Laparoscopic treatment of median arcuate syndrome. Intractable Rare Dis Res. 2019 May; 8(2): 108–112.10.5582/irdr.2019.01031
Search in Google Scholar Back to article
6. Gander S, Mulder DJ, Jones S, Ricketts JD, Soboleski DA, Justinich CJ. Recurrent abdominal pain and weight loss in an adolescent: Celiac artery compression syndrome. Can J Gastroenterol. 2010; 24(2): 91–93.10.1155/2010/534654
Search in Google Scholar Back to article
7. Cina CS, Safar H. Successful treatment of recurrent celiac axis compression syndrome. A case report. Panminerva Med 2002; 44: 69–72.
Search in Google Scholar Back to article
8. Loukas M, Pinyard J, Vaid S, Kinsella C, Tariq A, Tubbs RS. Clinical anatomy of celiac artery compression syndrome: A review. Clin Anat 2007; 20: 612–7.10.1002/ca.20473
Search in Google Scholar Back to article
9. Randhawa S, Patil AM, Kelkar AB, Kelkar AB. Median arcuate ligament syndrome: A diagnosis on CT abdominal angiography in cases of non-specific abdominal pain. Medical Journal of Dr. D.Y. Patil University | September-October 2015 | Vol 8 | Issue 5. DOI: 10.4103/0975-2870.16494710.4103/0975-2870.164947
Search in Google Scholar Back to article
10. Ozel A, Toksoy G, Ozdogan O, Mahmutoglu AS, Karpat Z. Ultrasonographic diagnosis of median arcuate ligament syndrome: a report of two cases. Medical Ultrasonography 2012, Vol. 14, no. 2, 154–157.
Search in Google Scholar Back to article
11. Bech FR. Celiac artery compression syndromes. Surg Clin North Am 1997; 77: 409–424.10.1016/S0039-6109(05)70558-2
Search in Google Scholar Back to article
12. H. Gruber, A. Loizides, S. Peer, I. Gruber. Ultra-sound of the median arcuate ligament syndrome: a new approach to diagnosis. Medical Ultrasonography 2012, Vol. 14, no. 1, 5–9.
Search in Google Scholar Back to article
13. J. Cernigliaro, F. Chen, S. Bhatt. The “Hook” sign of median arcuate ligament syndrome on ultrasound. Abdom Radiol. 2021 May; 46(5): 2251–2252. doi: 10.1007/s00261-020-02842-7. Epub 2020 Nov 3
Search in Google Scholar Back to article
14. Horton KM, Talamini MA, Fishman EK. Median arcuate ligament syndrome: evaluation with CT angiography. RadioGraphics 2005; 25: 1177–1182.10.1148/rg.25505500116160104
Search in Google Scholar Back to article
15. San Norberto EM, Romero A, Fidalgo Domingos LA, Garcia Saiz I, Taylor J, Vaquerol C. Laparoscopic treatment of median arcuate ligament syndrome: a systematic review. International Angiology 2019 December; 38(6): 474–83 DOI: 10.23736/S0392-9590.19.04161-0.10.23736/S0392-9590.19.04161-031580040
Search in Google Scholar Back to article
16. Ogino H, Sato Y, Banno T, Arakawa T, Hara M. Embolization in a patient with ruptured anterior inferior pancreaticoduodenal arterial aneurysm with median arcuate ligament syndrome. Cardiovasc Intervent Radiol 2002; 25: 318–9.10.1007/s00270-001-0109-412016519
Search in Google Scholar Back to article

Chronic Abdominal Pain, an Overlooked Diagnosis of Median Arcuate Ligament Syndrome (MALS)

Abstract

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