Median Arcuate Ligament Syndrome

Ihsan Al-Bayati, MD, First Year Resident, Department of Internal Medicine, Texas Tech University, Paul L. Foster School of Medicine Richard W. McCallum, MD, Professor and Founding Chair of Medicine, Department of Internal Medicine Director, Center of Neurogastroenterology and GI Motility, El Paso, TX Median arcuate ligament syndrome is an uncommon disorder first described in the 1960s. It is characterized by epigastric abdominal pain accentuated by meals and weight loss associated with nausea, vomiting and gastroparesis. Abnormal gastric electrical rhythm has also been reported. Abdominal bruit is a striking feature that is present in some cases. It is a diagnosis of exclusion that should be considered when there is a subjective presentation of severe epigastric and right upper quadrant abdominal pain which is out of proportion to objective findings. Whether using Doppler study, CT angiography, MRA or angiography, the main and most important goal is assessing both inspiratory and expiratory phases of the celiac artery to demonstrate reduction in the compression during inspiration. The treatment is surgical release of the median arcuate ligament to achieve decompression of the celiac artery and the celiac plexus. An evolving role for endoscopic ultrasound both in diagnosis and management is also discussed.