Median Arcuate Ligament Syndrome(MALS) – A Case Report On The Use Of EUS As A Diagnostic And Therapuetic Tool Prior To Definitive Sugery

Aims Median arcuate ligament syndrome (MALS) is a rare condition with unknown etiology resulting from compression of the celiac artery by the median arcuate ligament (MAL). MALS is characterized by abdominal pain, weight loss, and abdominal bruit. CT angiography (CTA) may demonstrate compression of the celiac artery by the MAL. Data are limited on the value of EUS with celiac plexus block (CPB) for the treatment of MALS.

Methods This is a case of a 35-year-old female with several years of abdominal pain. She had a past surgical history of sleeve gastrectomy. Recent CTA showed celiac artery stenosis with post-stenotic dilatation suggesting MALS. Given her previous bariatric surgery, an initial minimally invasive approach was recommended by performing EUS with CPB to assess if there would be lasting pain relief and thus predict a subsequent beneficial surgical response.

Results EUS was performed and the celiac ganglia were identified. 7ml of 0.25% Bupivacaine was injected into the celiac plexus. Shortly after EUS, the patient reported no abdominal pain. Six weeks later, however, she was readmitted to hospital with recurrent abdominal pain. Repeat EUS with CPB was performed, and again an immediate therapeutic effect was reported. Given this positive therapeutic response, it was decided proceed with surgical intervention. Successful surgery with MAL release was performed. Persisting symptom relief has been achieved and repeat CTA demonstrates no celiac artery stenosis.

Conclusions In conclusion, for patients with suspected MALS, EUS with CPB can improve patient symptoms, and may help to selectively identify appropriate patients for subsequent surgical intervention.

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Artikel online veröffentlicht:
14. April 2023