title: Surgical treatment of median arcuate ligament syndrome: case report and review of literature.
abstract: BACKGROUND
  Median arcuate ligament (MAL) syndrome, also called celiac trunk compression syndrome (CACS) or Dunbar syndrome is a rare disorder caused by compression of the celiac artery by median arcuate ligament of the diaphragm, which leads to mesenteric ischemia and chronic abdominal angina. The typical clinical triad of symptoms includes postprandial epigastric pain, weight loss and vomiting. The gold standard for MAL syndrome diagnosis is selective angiography, while in symptomatic patients with angiographically verified stenosis the optimal therapy is surgical treatment.
  
  
  METHODS
  A 40-year-old male patient was presented with epigastric pain, followed by dyspepsia and weight loss. The upper endoscopy showed gastric and duodenal distention with prominent folds of gastric mucosa and slow peristalsis. Selective angiography showed stenosis (90%) of initial segment of the celiac trunk. Adhesiolysis with the transection of the median arcuate ligament was performed. Due to repeated symptoms, the patient was reoperated on the 10th postoperative day with performed adhesiolysis and gastrostomy for gastric nutrition. Two months later, the patient was rehospitalized for closure of gastrostomy. At five years follow-up, selective angiography showed no stenosis of the initial segment of the celiac artery.
  
  
  CONCLUSIONS
  Despite the existing controversy concerning pathophysiological mechanism, the clinical presentation and treatment modalities of patients with MAL syndrome, it is evident that careful selection and adequate surgical treatment may significantly reduce symptoms in these patients.
authors.forename: Milutin
authors.initials: M
authors.lastname: Kotarać
authors.forename: Nebojša
authors.initials: N
authors.lastname: Radovanović
authors.forename: Nebojša
authors.initials: N
authors.lastname: Lekić
authors.forename: Zoran
authors.initials: Z
authors.lastname: Ražnatović
authors.forename: Vladimir
authors.initials: V
authors.lastname: Djordjević
authors.forename: Dragana
authors.initials: D
authors.lastname: Lekć
authors.forename: Dragan
authors.initials: D
authors.lastname: Sagić
mesh_terms: D015746:Abdominal Pain / Q000209:etiology; D000328:Adult; D000792:Angiography; D002445:Celiac Artery / Q000002:abnormalities* / Q000601:surgery; D003251:Constriction, Pathologic / Q000150:complications / Q000175:diagnosis* / Q000601:surgery*; D006801:Humans; D008297:Male; D000074742:Median Arcuate Ligament Syndrome; D013577:Syndrome