Median Arcuate Ligament Syndrome with Superior Mesenteric Artery Thrombosis

Abstract :

Median arcuate ligament syndrome (MALS) is a rare etiology of chronic abdominal pain, clinically characterized by the triad of postprandial abdominal pain, weight loss, and often an abdominal uit due to compression of the celiac artery by the median arcuate ligament. Given the nonspecific symptoms, this is a rare and difficult diagnosis to obtain. Symptomatic Superior Mesenteric Artery(SMA) thrombosis most often accompanies celiac occlusion. Thrombosis of the SMA (approximately 25% of cases) is usually associated with pre-existing chronic atherosclerotic disease leading to stenosis. History consistent with chronic mesenteric ischemia (CMI), including postprandial pain, weight loss, or food fear, and thus a systematic history is important when evaluating a patient suspected to have AMI. We present a patient with postprandial abdominal pain with fear of food intake, vomitings and weight loss, in whom etiology was ultimately determined to be median arcuate ligament syndrome with SMA thrombosis. Decompression of median arcuate ligament and revascularization is done.

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