Giakoustidis A, Moschonas S, Christodoulidis G, Chourmouzi D, Diamantidou A, Masoura S, Louri E, Papadopoulos VN, Giakoustidis D. Median arcuate ligament syndrome often poses a diagnostic challenge: A literature review with a scope of our own experience. World J Gastrointest Surg 2023; 15(6): 1048-1055 [PMID: 37405099 DOI: 10.4240/wjgs.v15.i6.1048]
Corresponding Author of This Article
Gregory Christodoulidis, MD, PhD, Consultant Physician-Scientist, Department of General Surgery, University Hospital of Larissa, Mezourlo, Larissa 41110, Greece. gregsurg@yahoo.gr
Research Domain of This Article
Surgery
Article-Type of This Article
Minireviews
Open-Access Policy of This Article
This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
World J Gastrointest Surg. Jun 27, 2023; 15(6): 1048-1055 Published online Jun 27, 2023. doi: 10.4240/wjgs.v15.i6.1048
Median arcuate ligament syndrome often poses a diagnostic challenge: A literature review with a scope of our own experience
Alexandros Giakoustidis, Stavros Moschonas, Gregory Christodoulidis, Danae Chourmouzi, Anna Diamantidou, Sophia Masoura, Eleni Louri, Vasileios N Papadopoulos, Dimitrios Giakoustidis
Alexandros Giakoustidis, Stavros Moschonas, Vasileios N Papadopoulos, Dimitrios Giakoustidis, Department of Surgery, General Hospital Papageorgiou, Aristotle University of Thessaloniki, Thessaloniki 56429, Greece
Alexandros Giakoustidis, Danae Chourmouzi, Anna Diamantidou, Sophia Masoura, Eleni Louri, Dimitrios Giakoustidis, Fifth Department of Surgery, Interbalkan European Medical Centre, Thessaloniki 55535, Greece
Gregory Christodoulidis, Department of General Surgery, University Hospital of Larissa, Larissa 41110, Greece
Author contributions: Giakoustidis A designed the study, wrote most of the manuscript, and performed manuscript revisions; Moschonas S designed the study and wrote most of the manuscript; Christodoulidis G offered guidance and assisted as a corresponding author; Chourmouzi D, Diamantidou A, Masoura S, and Louri E assisted in writing part of the introduction and performed manuscript revisions; Papadopoulos VN and Giakoustidis D performed manuscript revisions.
Conflict-of-interest statement: The authors declare no conflict of interests for this article.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Gregory Christodoulidis, MD, PhD, Consultant Physician-Scientist, Department of General Surgery, University Hospital of Larissa, Mezourlo, Larissa 41110, Greece. gregsurg@yahoo.gr
Received: December 27, 2022 Peer-review started: December 27, 2022 First decision: January 22, 2023 Revised: February 5, 2023 Accepted: April 18, 2023 Article in press: April 18, 2023 Published online: June 27, 2023 Processing time: 169 Days and 16.2 Hours
Abstract
The median arcuate ligament syndrome (MALS) is recognized as a rare clinical entity, characterized by chronic post-prandial abdominal pain, nausea, vomiting, and unintentional weight loss. Due to its vague symptomatology, it is mainly regarded as a diagnosis of exclusion. Patients can often be misdiagnosed for several years before a correct diagnosis is established, also due to a medical team’s clinical suspicion. We present a case series of two patients who suffered from MALS and were treated successfully. The first patient is a 32-year-old woman, presenting with post-prandial abdominal pain and weight loss that have lasted for the past ten years. The second patient, a 50-year-old woman, presented with similar symptomatology, with the symptoms lasting for the last five years. Both cases were treated by laparoscopic division of the median arcuate ligament fibers, which alleviated extrinsic pressure from the celiac artery. Previous cases of MALS were retrieved from PubMed, to assemble a better diagnostic algorithm and propose a treatment method of choice. The literature review suggests an angiography with a respiratory variation protocol as the diagnostic modality of choice, along with the laparoscopic division of the median arcuate ligament fibers as the proposed treatment of choice.
Core Tip: Due to its rarity, reviews, meta-analyses, and guidelines regarding median arcuate ligament syndrome (MALS) are rare. Most data can be extracted by individual case reports and case series. Even though MALS has a low frequency among the general population, more and more studies continue to support the claim that an increasing percentage of people may be prone to present characteristics of the syndrome. Thus, using this case series of patients as an example, we explore the literature with an aim to propose an improved diagnostic algorithm and treatment of choice.
