A KINKY AFFAIR! pawartejaswinim91@gmail.com

PW03-18

A KINKY AFFAIR!

4

 

 

 

 

India

Poster with Discussion

MAL syndrome was first described anatomically by Lipshutz in 1917 in cadaveric dissections where celiac artery was sometimes overlapped by the diaphragmatic crura.

57 year old male ,complaints of pain abdomen on and off more in the epigastric region and aggravated on taking meal,reduced appetite and weight loss.Clinically vitals stable , abdomen – no abnormalities detected. He underwent OGD for the same complaints and was diagnosed to have antral gastritis with rapid urease test positive. Contrast CT abdomen and pelvis with angiography showed medial arcuate ligament syndrome with 40-50% stenosis. Doppler showed increased velocities > 220cm/s in the coeliac trunk.Patient underwent laparoscopic Medial Arcuate Ligament release. Post operative period was uneventful and he was discharged on POD1. Post operatively Doppler was done which showed reduction in the velocity to 120 cm/s in the coeliac trunk.

It is considered as a rare condition and is commonly considered as an diagnosis of exclusion.Conventional angiography is considered the gold standard diagnostic method; however, this is an invasive procedure.Duplex ultrasound and CTA/MRA -a peak systolic velocity of >200 cm/s on duplex ultrasound or >50% stenosis of the celiac artery on angiography. Treatment options being Decompression- Laproscopic(gold standard )/Open.

Patient may endure months to years of recurrent abdominal pain without knowledge of etiology. In patients with upper gastrointestinal disorders, especially postprandial pain that persists after medical therapy, it may be useful to perform vascular investigation sooner with duplex sonography to evaluate the possibility of median arcuate ligament syndrome.