Clinical Response to Celiac Plexus Block Confirms the Neurogenic Etiology of Median Arcuate Ligament Syndrome

Abstract

Single center, retrospective review between January 1, 2017, and April 3, 2020. Ninety-six patients (female, 75; mean age, 27 years) underwent 103 computed tomography (CT)‒guided percutaneous celiac plexus block (CPB) procedures for a presumptive diagnosis of median arcuate ligament syndrome (MALS). Technical success was achieved in 102 of 103 cases. No major adverse events were reported. The prevalence of postprandial nausea and vomiting significantly decreased after treatment (38% to 12%;16% to 5%, respectively). Findings of celiac artery compression were documented on CT scan in only 27% of these selected patients. The postprandial pain score decreased in 84% of patients overall; no differences were noted between patients with and without celiac artery compression. In patients with a clinical diagnosis of MALS, a large majority reported pain relief and decreased gastrointestinal symptoms after CPB. Pain relief did not correlate with the presence of celiac arterial stenosis. These findings support neuropathy as the primary etiology of MALS and suggests that the absence of celiac stenosis should not be used as an exclusion criterion.