Jesse Conner, MD, Joshua Gierman, MD, Laura Fischer, MD. Oklahoma University Health Science Center
Introduction: Median arcuate ligament syndrome is a rare cause of abdominal pain. Symptoms include vague epigastric pain, post prandial pain, nausea, vomiting, and weight loss. The pathophysiology has been thought to be secondary to compression of the celiac artery by a thick fibrous median arcuate ligament with resulting mesenteric ischemia. It is also hypothesized that a component of the pain is secondary to compression of the celiac nerve plexus. Diagnosis can be made through various imaging modalities however this syndrome is usually a diagnosis of exclusion. We hypothesize that patients who have resolution of their symptoms after a celiac plexus nerve block will benefit the most from operative treatment. Our aim is to present our experience in diagnosis and treatment of six patients presenting with signs and symptoms consistent with median arcuate ligament syndrome who ultimately underwent laparoscopic median arcuate release.
Methods: We performed a retrospective review of all patients undergoing a laparoscopic median arcuate release from July of 2016 to May of 2018. We collected data pertaining to their work up, complications, and outcomes of surgery regarding improvement of symptoms.
Results: We accrued six patients who underwent laparoscopic median arcuate ligament release. Preoperative symptoms ranged from post prandial pain to pain with nausea, vomiting, and associated weight loss. All patients had a CT angiogram suggesting compression of the celiac artery. Additionally, all patients underwent a celiac plexus nerve block with improvement or temporary resolution of their symptoms. Five of the six patients had complete resolution of their symptoms post-operatively, with one patient reporting improvement without complete resolution of his abdominal pain. There were no major complications, one patient did return to the ED with abdominal pain and constipation which resolved following appropriate bowel regimen.
Conclusion: Media arcuate ligament syndrome can be difficult to diagnose and treat. Our small case series suggests that performing a celiac plexus nerve block may help select patient that will benefit the most from operative treatment.
Presented at the SAGES 2017 Annual Meeting in Houston, TX.
Abstract ID: 95650
Program Number: V079
Presentation Session: Exhibit Hall Theater Video Session III
Presentation Type: EHVideo