Celiac Artery Aneurysm and Pseudoaneurysm Caused by Median Arcuate Ligament Syndrome (MALS) with Different Presentation: A Case Series

Abstract

Introduction: The median arcuate ligament syndrome (MALS) is a rare vascular disorder caused by an extrinsic compression of the celiac artery from the median arcuate ligament.It is associated with aneurysmal dilatation due to compression. Although it usually comes with the classical triad of chronic abdominal pain, weight loss and epigastric bruit , it still manifests a wide variety of symptoms. Method: We observed 3 cases of celiac trunk aneurysm associated with this condition presented to us initially with different symptoms and MALS were detected by computed tomography scan. Results: Case 1: a 67 year old lady presented with epigastric pain underwent CT showed superior and inferior pancreaticoduodenal artery aneurysm. Successful angioembolisation of aneurysm done and proceeded with release of median arcuate ligament. Case 2: A 56 year old gentleman presented with symptoms of gastric outlet obstruction, CT scan showed duodenal mass with GDA pseudoaneuryms, Whipple procedure was performed. Case 3. A 51 year old gentleman presented with obstructive jaundice and was diagnosed with pancreatic head carcinoma, proceeded with Whipple procedure, only to discover common hepatic and superior anterior pancreaticoduodenal artery pseudoaneurysm post surgery via digital subtraction angiography. Conclusion: Aneurysms associated with MAL syndrome is quite rare and may present with different symptoms at time of diagnosis. Angioembolisation should be the treatment of choice and followup for recurrence is warranted.