Median arcuate ligament syndrome with post stenotic pancreaticoduodenal aneurysm: case report

Background: Median arcuate ligament syndrome (celiac artery compression syndrome, Dunbar syndrome) is an infrequent form of chronic mesenterial ischemia. The culprit for a sub optimal celiac blood flow is a lowpositioned median arcuate ligament which is an arch of fibrous tissue connecting the diaphragmatic crura. Symptomatic patients complain of postprandial pain situated in the epigastrium. Still, most of the individuals proven to have some form of celiac artery compressions report no complaints at all. The gold standard for diagnosis is a CT angiography and treatment is surgical. The median arcuate ligament is transacted with or without additional endovascular treatment. Case study: We present the case of a 50-year-old male patient with a radiologically confirmed diagnosis of median arcuate ligament syndrome treated surgically at our institution. An open approach was used since the patient had a previous median laparotomy scar. Due to a post stenotic pancreaticoduodenal aneurysm coil embolization was additionally performed. On follow up the patient had no further complaints. Conclusion: Patients with chronic postprandial pain require a systematic approach. In the differential diagnosis of abdominal angina, although uncommon, median arcuate ligament syndrome is to be remembered. The diagnosis is rather straightforward once clinical suspicion is established and treatment-wise minimally invasive surgery is performed whenever possible