A Clinical Case of Laparoscopic Treatment of Median Arcuate Ligament Syndrome

Abstract

Median arcuate ligament syndrome (MALS), also referred to as Dunbar syndrome, is a rare vascular compression disorder characterized by extrinsic compression of the celiac artery by the median arcuate ligament. It commonly presents with vague gastrointestinal symptoms such as postprandial epigastric pain, nausea, anorexia, weight loss, and occasionally diarrhea. However, radiologic evidence of celiac artery compression is not uncommon in asymptomatic individuals, reported in up to 10–24% of cases, indicating that anatomical compression alone is insufficient for diagnosis. The pathophysiology of MALS is multifactorial, with a possible neurogenic component involving altered pain processing from the splanchnic plexus. As MALS is a diagnosis of exclusion, thorough evaluation is necessary to rule out other potential causes. Surgical decompression of the median arcuate ligament—via open, laparoscopic, or robot-assisted approaches—is the primary treatment, with endovascular therapy reserved for persistent stenosis following surgery.

This article presents a clinical case exemplifying the laparoscopic treatment of MALS. A 28-year-old female patient with a 7–8 year history of nonspecific abdominal symptoms experienced worsening pain and significant weight loss (18 kg) over the past month. Diagnostic imaging with duplex ultrasonography and computed tomography revealed a 75% proximal stenosis of the celiac artery. The patient underwent successful laparoscopic release of the median arcuate ligament. Postoperatively, all gastrointestinal symptoms resolved, peristalsis resumed within 12 hours, and the patient was able to eat normally the following day. Additionally, the abdominal bruit resolved. She was discharged one day after surgery and remained symptom-free during a 5-month follow-up period.