Median arcuate ligament syndrome (MALS): A case report of a young patient

Abstract

Median arcuate ligament syndrome (MALS) is a compressed celiac artery syndrome, also known as Dunbar syndrome. MALS is a clinically rare syndrome and is usually a diagnosis of exclusion. Diagnosis is a difficult task. Surgery is the treatment of choice, and laparoscopic surgery has promising results. A 40-year-old female with no comorbidities presented to her primary physician complaining of chronic abdominal pain, appetite loss, pain after eating, weight loss for about 5 years. Physical examination results were unremarkable. The abdomen/pelvis computed tomography angiography (CTA) was performed and 50% celiac artery stenosis was found. Due to inadequate symptom control and otherwise unremarkable workup, laparoscopic median arcuate ligament release was scheduled. The publication has been reported in line with the SCARE criteria. The etiology and pathophysiology of Dunbar syndrome are incompletely understood but may be related to both ischemic and neuropathic mechanisms. There are theories that MALS is associated with either a neurogenic or vascular origin for the clinical features, but objective evidence to support these theories is lacking. If MALS is suspected, abdominal/pelvic CTA can be used to verify the location of the celiac trunk. Despite the controversy regarding the pathophysiology, most patients with MALS have a good response to laparoscopic decompression. MALS is a rare and incompletely understood syndrome. Laparoscopic median arcuate ligament release and transection of the celiac plexus is an effective treatment for MALS.