Median Arcuate Ligament Syndrome: Treatment and Outcome.

Dr Sharvari Pujari; Dr Kishor Jain; Dr Rahul Raghavapuram; Dr Ramkrishna Prabhu; Dr Chetan Kantharia

Volume : IX, Issue : VII, July - 2019

Median Arcuate Ligament Syndrome: Treatment and Outcome.

Dr Sharvari Pujari, Dr Kishor Jain, Dr Rahul Raghavapuram, Dr Ramkrishna Prabhu, Dr Chetan Kantharia

Abstract :

Introduction: Median arcuate ligament syndrome is a symptom complex occurring following compression of celiac artery (CA) by a fious arch. This fious arch originates from the diaphragmatic crura on either side of the aortic hiatus and passes superior to the origin of the celiac axis. The symptom complex comprises of chronic postprandial abdominal pain, weight loss, nausea and vomiting. The diagnosis is essentially clinical, confirmed on CECT Scan which showing focal narrowing at the proximal celiac axis. Surgical release of the compression (laparoscopic or open) is the treatment of choice. However a select group of patients respond well to conservative treatment as well. Although there are several case reports and series in literature, very few studies outline the management strategy. The present study outlines the management protocol and also the follow–up of the outcome of treatment. Material and Methods: A retrospective analysis of a prospectively maintained database at the Surgical Gastroenterology Department of a tertiary referral Public Hospital was performed for the period January 2010 until December 2017. Patients with celiac artery compression syndrome were identified and their records analyzed. The parameters studied were their demographics, clinical presentation, diagnostic investigations, the treatment offered, its outcome and the follow–up progress. Results: Eight patients (5 males) were identified during the study period. The mean age was 26 years. Six patients were treated surgically (5 Laparoscopic and 1 open). Surgery comprised of division of median arcuate ligament division and celiac ganglion neurolysis.2 patients who did not consent for surgery were treated symptomatically. Mean follow–up was 39.2 months. Patients treated surgically improved symptomatically with no patient having recurrence of symptoms. Conclusion: Surgery is an effective treatment for celiac artery compression syndrome. Both open and laparoscopic approaches are safe with same outcome