Laparoscopic Median Arcuate Ligament Release: A Case Report

Roman Grinberg, MD, Ting Kin Leung, DO, John N Afthinos, MD, Karen E Gibbs, MD. Staten Island University Hospital

We present the case of a 73-year-old lady with a history of diabetes, hypertension and hypercholesterolemia who presented to the Emergency Department with severe, epigastric post-prandial abdominal pain. The pain had been present for nearly a year. She experienced a 14 pound weight loss in the past month. Workup revealed no evidence of ulcer or gastroparesis. MRI and CT of the abdomen suggested compression of the celiac artery by the median arcuate ligament of the diaphragm. Doppler velocities of 396 cm/s correlated with ~70% stenosis. An elective laparoscopic median arcuate ligament release was performed. Her post-operative course was uneventful and she tolerated diet without further pain. We present a video of our technique. 

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