Abstract

Introduction: Median arcuate ligament syndrome (MALS), also known as Dunbar syndrome or celiac artery compression syndrome, is a rare disorder due to external compression of the celiac trunk (CT) by the median arcuate ligament (MAL). The diagnosis is difficult and often one of exclusion, because of its nonspecific symptoms that overlap with other forms of chronic intestinal ischemia. Laparoscopic approach is considered to be an optimal therapeutic option. Material and Surgical Techniques: We describe the case of a 40-year-old woman who presented with a 4 years-long clinical history of postprandial abdominal pain, occasional vomiting and severe weight loss in the last year. An abdominal CT scan demonstrated an external compression of the CT and the patient underwent laparoscopic decompression by division of the MAL. Postoperative course was uneventful and the patient was discharged on the 5th postoperative day. Discussion: Despite being MALS a rare disease, it must be kept in the differential diagnosis of abdominal pain. Diagnosis is difficult and often requires 2nd level investigations. Laparoscopy can be useful both as a diagnostic and curative approach. The laparoscopic division of the MAL is a feasible and safe procedure, leading to an improved quality of life

Highlights

  • Median arcuate ligament syndrome (MALS), known as Dunbar syndrome or celiac artery compression syndrome, is a rare disorder due to external compression of the celiac trunk (CT) by the median arcuate ligament (MAL)

  • Median arcuate ligament syndrome (MALS), known as Dunbar syndrome, refers to chronic and recurrent abdominal pain resulting from the compression of the celiac trunk (CT) by the median arcuate ligament (MAL)

  • We proposed to the patient a laparoscopic exploration and section of the MAL and obtained the informed consent

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Summary

Introduction

Median arcuate ligament syndrome (MALS), known as Dunbar syndrome, refers to chronic and recurrent abdominal pain resulting from the compression of the celiac trunk (CT) by the median arcuate ligament (MAL). The patient reported an unintentional weight loss of 15 Kg in the last year She had no history of chronic disease or drug use and was a non-smoker. Her family history was negative for neoplasm and her only past surgery was a laparoscopic appendectomy. The Left Gastric Artery (LGA) and the Common Hepatic Artery (CHA) were isolated and hold medially and laterally with a tape Following this manoeuvre, the fibrotic and muscular structures imprinting the origin of the CT were well visualized and divided by using an ultrasonic energy device. Three months after her discharge, the patient reported that she was pain-free and that she would eat regularly without any discomfort

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