Desmond T Huynh, MD, Mohan Mallipeddi, MD, Miguel Burch, MD, Edward Phillips, MD, Scott Cunneen, MD, Richard J Van Allan, MD, Daniel Shouhed, MD. Cedars-Sinai Medical Center
Introduction: Median Arcuate Ligament Syndrome(MALS) has been described in the literature as presenting with a constellation of symptoms including nausea, vomiting, weight loss, and post-prandial epigastric pain. While many of these symptoms are consistent with foregut pathology, a cohort of patients with MALS presenting with delayed gastric emptying has not been described in the literature. In this study we report on the possible association of MALS with delayed gastric emptying.
Methods: Cases of MAL release were collected between 2013 and 2017. Eight patients were identified who presented with MALS and underwent subsequent MAL release. All 8 patients underwent laparoscopic or robotic surgery. Patients were compiled into a retrospective database and their demographic, symptomatic, imaging, and outcomes data were analyzed.
Results: The mean age of the population was 46.5(16-71). The mean BMI was 25.8(13.4-43.8). Patients were followed for an average of 12.4(1-45) months. Seven(88%) patients had preoperative symptoms: 7(88%) post-prandial pain, 5(63%) abdominal pain, 4(50%) sitophobia, 1(13%) bloating, 1(13%) nausea. Six patients(75%) presented with weight loss with a mean weight loss of 11.95 kg(6.8-20). All 8 patients underwent either CT or MR angiography demonstrating celiac trunk stenosis, with a mean stenosis of 75.8%(50-99). Three(37.5%) patients showed anatomic abnormalities of the mesenteric vasculature. Six(75%) patients underwent preoperative dynamic duplex ultrasound demonstrating a mean celiac trunk systolic velocity of 243.8(152-318) cm/s and a mean diastolic velocity of 72.6(36-96) cm/s. Three(37.5%) of the 8 patients received gastric emptying studies, with all 3 patients showing delayed gastric emptying. Two(25%) of the 8 patients underwent upper gastrointestinal studies and both were found to have delayed gastric emptying. Following MAL release 3(37.5%) patients experienced 100% resolution of symptoms, 1(12.5%) experienced 75% resolution, and 3(37.5%) did not have any resolution of symptoms. Of these patients whose symptoms were refractory to MAL release, 2(25%) had a history of foregut surgery prior to MAL release.
Conclusion: We report for the first time, to our knowledge, a possible association between MALS and delayed gastric emptying. In our study sample, after patients underwent surgery for MALS, most had resolution of their symptoms, including those patients with delayed gastric emptying. Consideration should be given to work up patients for MALS when they present with delayed gastric emptying and typical symptoms associated with MALS. Our study is limited by the small sample size.
Presented at the SAGES 2017 Annual Meeting in Houston, TX.
Abstract ID: 88074
Program Number: P388
Presentation Session: iPoster Session (Non CME)
Presentation Type: Poster