Median arcuate ligament syndrome can be treated with endovascular surgery, open or laparoscopic surgery of median arcuate ligament liberation and vascular surgery
7. In a study, provided vascular reparation by performing bypass between aorta and celiac artery with dacron graft or by patching saphenous vein on celiac artery
7. The most commonly accepted treatment method is open or laparoscopical liberation of median arcuate ligament compressing celiac trunk and dividing surrounding lymphatic and nerve tissue
8. In this case fibers of median arcuate ligament which compressed celiac trunk were laparoscopically cut and liberated.
After the diagnosis of median arcuate ligament syndrome, patients with mild symptoms may be treated with vasodilator agents. Luminal dilatation via percutaneous route is another treatment method. In general, percutane transluminal angioplasty provides short time relief of symptoms however surgery is the actual treatment of this syndrome. When these 3 methods were analyzed, smyptoms were disappeared in 53 % and 79 % of the patients7-9.
According to datas, post operative recurrence rate was 12.5 % and symptomatic relief has been succeeded in all cases. Reseborough et al. determined the recurrence rate as 27% and symptomatic relief rate as 95% in a case series of 15 patients11. Similarly, our patient was symptom free on the 9. postoperative day and preoperative complaints of the patient totally disappeared.
Anatomic location of celiac artery is between 11. Thoracic vertebrae and 1. lumbar vertebrae3. Loukas et al. underlined the variability of celiac trunk's origin based on diaphragmatic crura morphology12. General observations show that celiac artery is exposed to greater pressure of median arcuate ligament when it originates above the 11. thoracic vertebrae. More proximal localisation of celiac artery is observed more commonly in females than in males; consequently median arcuate ligament syndrome is more commonly seen in females. In this patient, no anatomic abnormality of celiac artery origin could be detected in CT angiography images.
Six anatomical and morphologic variations of aortic and esophageal hiatus are described. The most common type (Type 1, 45%) comprises an esophageal hiatus formed by muscular contributions arising solely from the right crus. In Type 2 (20%) the esophageal hiatus is formed by muscular contributions from the right and left crura. In Type 3 (15%), the right and left muscular contributions arise from the right crus with an additional band from the left crus. In Type 4 (10%) the right and left muscular contributions arise from the right crus, with two additional (anterior and posterior) bands arising from the left crus. Type 5 (5%) arises solely from the left crus. In Type 6 (5%) the right and left contributions originate from the left crus with two additional bands, one from the right crus and one from the left crus. Our patient has been categorized as Type 1 in a meeting held with radiologists.
As a result; MALcompression sydrome should be considered when a young, middleaged, thin women complains of nausia, vomiting and postprandial epigastric pain aggravated by expiration and having the history of weight loss in a short time. Multislice CT angiography should be performed when establishing diagnosis due to the advantages of 3D imaging. After the diagnosis, best results and short postoperative process can be achieved in experienced laparoscopic surgery centers by cutting median arcuate ligament and removing tissue surrounding the celiac artery. We believe that the presense of a cardiovascular surgeon in the operation may be useful for repairing possible vascular injuries.