Case Report
Copyright ©The Author(s) 2023. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Clin Cases. Nov 16, 2023; 11(32): 7881-7887
Published online Nov 16, 2023. doi: 10.12998/wjcc.v11.i32.7881
Median arcuate ligament syndrome complicated with gallbladder stones: A case report
Jun-Qiang Dang, Qing-Qiang Wang, Yan-Ling Yang, Lin Shang, Qi-Tian Bian, Hong-Jun Xiang
Jun-Qiang Dang, Lin Shang, Qi-Tian Bian, Hong-Jun Xiang, Department of Hepatobiliary Surgery, Xi’an Daxing Hospital, Xi’an 710016, Shaanxi Province, China
Qing-Qiang Wang, Yan-Ling Yang, Department of Hepatobiliary and Pancreatic Surgery, Xijing Hospital, Air Force Medical University, Xi’an 710032, Shaanxi Province, China
Informed consent statement: Written informed consent was obtained from both patients for the publication of any potentially identifiable images or data included in this article.
Conflict-of-interest statement: All the authors declare that they have no conflict of interest.
CARE Checklist (2016) statement: The authors have read the CARE Checklist (2016), and the manuscript was prepared and revised according to the CARE Checklist (2016).
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: Hong-Jun Xiang, MD, Deputy Chief Doctor, Department of Hepatobiliary Surgery, Xi’an Daxing Hospital, No. 353 Rodong North Road, Xi’an 710016, Shaanxi Province, China. xianghj1973@126.com
Received: September 4, 2023
Peer-review started: September 4, 2023
First decision: September 28, 2023
Revised: October 11, 2023
Accepted: November 9, 2023
Article in press: November 9, 2023
Published online: November 16, 2023
Abstract
BACKGROUND

Median arcuate ligament syndrome (MALS) is a rare disease caused by compression of the celiac trunk artery by the median arcuate ligament (MAL). It can cause symptoms of postprandial abdominal pain, weight loss, and nausea and vomiting.

CASE SUMMARY

A 55-year-old woman was admitted due to abdominal pain, nausea and vomiting. On admission, the patient presented with epigastric pain that worsened after eating, without signs of peritoneal irritation. Computed tomography angiography of the upper abdomen showed compression of the proximal segment of the abdominal trunk, local luminal stenosis with angular “fishhook” changes, which changed significantly during forceful inspiration and expiration; gallbladder stones; and multiple cysts in the liver. Abdominal duplex ultrasonography showed that peak systolic velocity was 352 cm/s. After diagnosis of MALS was confirmed, an arch ligament release procedure was performed. MALS has no specific symptoms and can be misdiagnosed as other abdominal diseases. Awareness of MALS should be improved to avoid misdiagnosis. The commonly used treatment option is MAL release and resection of the peripheral ganglion of the celiac trunk artery.

CONCLUSION

The diagnosis and treatment of MALS must be individualized, and MAL release is effective and provides immediate symptomatic relief.

Keywords: Median arcuate ligament syndrome, Celiac artery compression syndrome, Operative decompression, Case report

Core Tip: Median arcuate ligament syndrome (MALS) is a rare disorder caused by compression of the median arcuate ligament against the celiac trunk. Patients with MALS often present with chronic postprandial abdominal pain, nausea, vomiting, diarrhea, and unexplained weight loss. Imaging examination is the preferred screening method. MALS is confused with many common diseases, and definitive diagnosis requires exclusion of other causes of abdominal pain. In this case, combination of gallbladder stones and chronic cholecystitis made it easy to miss diagnosis of MALS. Clinicians should be more aware of MALS. Surgery can provide immediate symptomatic relief and can be an effective treatment for MALS.