title: Median arcuate ligament syndrome in athletes.
abstract: Exercise-related transient abdominal pain (ETAP) is a common entity in young athletes. Most occurrences are due to a "cramp" or "stitch," but an uncommon, and often overlooked, etiology of ETAP is median arcuate ligament syndrome (MALS). The initial presentation of MALS typically includes postprandial nausea, bloating, abdominal pain, and diarrhea, but in athletes, the initial presentation may be ETAP.
  
  
  
  We present a case series of three athletes who presented with exercise-related transient abdominal pain and were ultimately diagnosed and treated for MALS. Unlike other patients with median arcuate ligament syndrome, these athletes presented with exercise-induced pain, rather than the common postprandial symptoms. These symptoms persisted despite conservative measures. Work-up of patients with suspected MALS include a computed tomography or magnetic resonance angiography showing compression of the celiac artery with post-stenotic dilation, or a celiac artery ultrasound demonstrating increased velocities (>200 cm/s2) with deep exhalation.
  
  
  
  All patients underwent a laparoscopic median arcuate ligament release. Postoperatively, there were no complications, and all were discharged home on postoperative day #2. All patients have subsequently returned to athletics with resolution of their symptoms.
  
  
  
  ETAP is common in athletes and often resolves with preventative or conservative strategies. When ETAP persists despite these methods, alternative causes, including MALS, should be considered. A combination of a thorough history and physical exam, as well as radiographic data, is essential to make the appropriate diagnosis and treatment strategy.
authors.affiliation: Department of Surgery, The George Washington University Medical Center, The George Washington University, 2150 Pennsylvania Ave, NW Suite 6B, Washington, DC, 20037, USA.
authors.forename: Jeffrey N
authors.initials: JN
authors.lastname: Harr
authors.affiliation: Department of Surgery, The George Washington University Medical Center, The George Washington University, 2150 Pennsylvania Ave, NW Suite 6B, Washington, DC, 20037, USA.
authors.forename: Ivy N
authors.initials: IN
authors.lastname: Haskins
authors.affiliation: Department of Surgery, The George Washington University Medical Center, The George Washington University, 2150 Pennsylvania Ave, NW Suite 6B, Washington, DC, 20037, USA. fbrody@mfa.gwu.edu.
authors.forename: Fred
authors.initials: F
authors.lastname: Brody
mesh_terms: D015746:Abdominal Pain / Q000209:etiology; D056352:Athletes; D002445:Celiac Artery / Q000002:abnormalities* / Q000000981:diagnostic imaging / Q000601:surgery; D003251:Constriction, Pathologic / Q000150:complications / Q000000981:diagnostic imaging / Q000601:surgery*; D015444:Exercise; D006801:Humans; D010535:Laparoscopy / Q000379:methods; D008022:Ligaments / Q000601:surgery*; D018810:Magnetic Resonance Angiography; D000074742:Median Arcuate Ligament Syndrome; D019518:Postprandial Period; D014057:Tomography, X-Ray Computed
keywords: Athletes; Celiac artery compression syndrome; Exercise-related transient abdominal pain; Median arcuate ligament syndrome