Kiudelis Mindaugas, Pažusis Matas, Kiudelis Vytautas, Kupčinskas Juozas, Žvinienė Kristina
Department of Surgery, Lithuanian University of Health Sciences, Kaunas, Lithuania.
Department of Surgery, Lithuanian University of Health Sciences, Kaunas, Lithuania.
Int J Surg Case Rep. 2025 Apr;129:111178. doi: 10.1016/j.ijscr.2025.111178. Epub 2025 Mar 19.
Median arcuate ligament syndrome (MALS) is a compressed celiac artery syndrome, also known as Dunbar syndrome. MALS is a clinically rare syndrome and is usually a diagnosis of exclusion. Diagnosis is a difficult task. Surgery is the treatment of choice, and laparoscopic surgery has promising results.
A 40-year-old female with no comorbidities presented to her primary physician complaining of chronic abdominal pain, appetite loss, pain after eating, weight loss for about 5 years. Physical examination results were unremarkable. The abdomen/pelvis computed tomography angiography (CTA) was performed and 50% celiac artery stenosis was found. Due to inadequate symptom control and otherwise unremarkable workup, laparoscopic median arcuate ligament release was scheduled. The publication has been reported in line with the SCARE criteria [13].
The etiology and pathophysiology of Dunbar syndrome are incompletely understood but may be related to both ischemic and neuropathic mechanisms. There are theories that MALS is associated with either a neurogenic or vascular origin for the clinical features, but objective evidence to support these theories is lacking. If MALS is suspected, abdominal/pelvic CTA can be used to verify the location of the celiac trunk. Despite the controversy regarding the pathophysiology, most patients with MALS have a good response to laparoscopic decompression.
MALS is a rare and incompletely understood syndrome. Laparoscopic median arcuate ligament release and transection of the celiac plexus is an effective treatment for MALS.
正中弓状韧带综合征（MALS）是一种腹腔干受压综合征，也称为邓巴综合征。MALS是一种临床罕见的综合征，通常是一种排除性诊断。诊断是一项艰巨的任务。手术是首选的治疗方法，腹腔镜手术取得了令人满意的效果。
一名40岁无合并症的女性因慢性腹痛、食欲不振、进食后疼痛、体重减轻约5年就诊于她的初级医生。体格检查结果无异常。进行了腹部/盆腔计算机断层扫描血管造影（CTA），发现腹腔干狭窄50%。由于症状控制不佳且其他检查无异常，计划进行腹腔镜正中弓状韧带松解术。本病例报告已按照SCARE标准[13]进行报告。
邓巴综合征的病因和病理生理学尚未完全明确，但可能与缺血和神经病变机制有关。有理论认为MALS的临床特征与神经源性或血管源性有关，但缺乏支持这些理论的客观证据。如果怀疑MALS，可使用腹部/盆腔CTA来确认腹腔干的位置。尽管关于病理生理学存在争议，但大多数MALS患者对腹腔镜减压治疗反应良好。
MALS是一种罕见且尚未完全了解的综合征。腹腔镜正中弓状韧带松解术和腹腔神经丛切断术是治疗MALS的有效方法。
