Giakoustidis Alexandros, Moschonas Stavros, Christodoulidis Gregory, Chourmouzi Danae, Diamantidou Anna, Masoura Sophia, Louri Eleni, Papadopoulos Vasileios N, Giakoustidis Dimitrios
Department of Surgery, General Hospital Papageorgiou, Aristotle University of Thessaloniki, Thessaloniki 56429, Greece.
Fifth Department of Surgery, Interbalkan European Medical Centre, Thessaloniki 55535, Greece.
World J Gastrointest Surg. 2023 Jun 27;15(6):1048-1055. doi: 10.4240/wjgs.v15.i6.1048.
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.
正中弓状韧带综合征（MALS）是一种罕见的临床病症，其特征为慢性餐后腹痛、恶心、呕吐及非刻意性体重减轻。因其症状模糊，主要被视为一种排除性诊断。由于医疗团队的临床怀疑，患者在确诊前往往会被误诊数年。我们报告了两例成功治疗的MALS患者病例系列。首例患者为一名32岁女性，餐后腹痛和体重减轻症状已持续十年。第二例患者为一名50岁女性，有类似症状，且症状已持续五年。两例均通过腹腔镜下切断正中弓状韧带纤维进行治疗，从而减轻了腹腔干动脉的外在压力。从PubMed检索了既往的MALS病例，以构建更好的诊断算法并提出首选治疗方法。文献综述表明，采用呼吸变化方案的血管造影是首选的诊断方式，而腹腔镜下切断正中弓状韧带纤维是建议的首选治疗方法。
