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Nitsa Z, Kanavidis P, Hasemaki N, Katsargyris A, Charalabopoulos A. Laparoscopic Treatment of a Symptomatic Young Woman With Median Arcuate Ligament Syndrome. Cureus 2024; 16:e61989. [PMID: 38983979 PMCID: PMC11231802 DOI: 10.7759/cureus.61989] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/06/2024] [Indexed: 07/11/2024] Open
Abstract
Median arcuate ligament syndrome (MALS), also known as Dunbar syndrome, celiac axis syndrome, or celiac artery compression syndrome, is caused by a band of tissue called the median arcuate ligament that compresses the celiac artery and sometimes the celiac plexus too. MALS does not always cause symptoms, but when symptoms occur, surgery is the treatment of choice. This case report focuses on the case of a 27-year-old woman presenting with postprandial episodes of abdominal pain and vomiting accompanied by loss of weight, which was found to be MALS.
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Affiliation(s)
- Zoi Nitsa
- First Department of Surgery, Laiko General Hospital of Athens, Athens, GRC
| | | | - Natasha Hasemaki
- Second Department of Vascular Surgery, Laiko General Hospital of Athens, Athens, GRC
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Skelly CL, Stiles-Shields C, Goldenthal H, Bohr N, Feldman E, Mak GZ, Drossos T. Median arcuate ligament syndrome: a cost analysis to determine the economic burden of a rarely diagnosed disease. Front Psychol 2024; 14:1166744. [PMID: 38292522 PMCID: PMC10824967 DOI: 10.3389/fpsyg.2023.1166744] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2023] [Accepted: 12/19/2023] [Indexed: 02/01/2024] Open
Abstract
Background Chronic abdominal pain (CAP) is a medical condition resulting in enormous economic burden and healthcare utilization costs. One understudied source of CAP is the median arcuate ligament syndrome (MALS). MALS is often not diagnosed and treated for a variety of reasons, including the fact that MALS is highly comorbid with psychological symptoms and psychiatric disorders similar to CAP. To better inform future work on the study of MALS, we undertook a pilot study to estimate the economic impact and public health burden of this condition. We hypothesized that MALS imposes a significant public health burden. Methods Pediatric and adult patients enrolled in a prospective study undergoing multidisciplinary evaluation and treatment for MALS at a tertiary care facility were invited to participate in a brief self-report survey, the Direct and Indirect Medical Care Impact of MALS Form, to capture health care resources including procedures, surgeries, health care visits, and absenteeism (school and work). To estimate costs from the Direct and Indirect Medical Care Impact of MALS Form, the medical care usage data self-reported by patients were converted to dollar value utilizing FSC-93 billing data and corresponding current procedural terminology (CPT) codes for procedures and provider visits one year prior to surgery and then following surgery. Descriptive analyses were conducted to characterize the sample in terms of demographics and reported absences from school and work. Results One hundred and nineteen patients (mean age = 30.9 ± 13.0) completed the questionnaires, yielding a 57% response rate. 82.4% (n = 98) of the participants were female and 90.8% (n = 108) were non-Hispanic/Latine white. The mean and median surgical follow-up periods were 5.3 and 5.4 years, respectively. Overall, median cost of provider and ancillary healthcare provider visits for each patient was (US)$19,119 including the pre-operative and post-operative visits. The mean cost for providers alone was (US)$28,908. Wilcoxon signed-ranks tests indicated that the postoperative missed number of days of school were significantly lower than the pre-surgical number of missed school days (Z = -3.36, p = 0.001). Similarly, there were significantly less missed work-days following surgery than before for the entire sample (Z = -2.86, p = 0.004). Conclusion Median arcuate ligament syndrome imposes a large economic burden on patients and the healthcare system. The current findings, although reflective of a homogenous population, are adding to a growing body of literature suggesting that healthcare disparities play a role in the low rates of diagnosis and treatment of MALS.
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Affiliation(s)
- Christopher L. Skelly
- Department of Surgery, Section of Vascular and Endovascular Surgery, University of Chicago Medicine, Chicago, IL, United States
| | - Colleen Stiles-Shields
- Institute for Juvenile Research, Department of Psychiatry, The University of Illinois at Chicago, Chicago, IL, United States
| | - Hayley Goldenthal
- Department of Psychiatry and Behavioral Sciences, University of Chicago Medicine, Chicago, IL, United States
| | - Nicole Bohr
- Department of Surgery, Section of Vascular and Endovascular Surgery, University of Chicago Medicine, Chicago, IL, United States
- Department of Nursing Research, University of Chicago Medicine, Chicago, IL, United States
| | - Estee Feldman
- Department of Psychiatry and Behavioral Sciences, University of Chicago Medicine, Chicago, IL, United States
| | - Grace Zee Mak
- Department of Surgery, Section of Pediatric Surgery, University of Chicago Medicine, Chicago, IL, United States
| | - Tina Drossos
- Department of Psychiatry and Behavioral Sciences, University of Chicago Medicine, Chicago, IL, United States
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Upshaw W, Richey J, Ravi G, Chen A, Spillers NJ, Ahmadzadeh S, Varrassi G, Shekoohi S, Kaye AD. Overview of Median Arcuate Ligament Syndrome: A Narrative Review. Cureus 2023; 15:e46675. [PMID: 37942382 PMCID: PMC10629207 DOI: 10.7759/cureus.46675] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2023] [Accepted: 10/07/2023] [Indexed: 11/10/2023] Open
Abstract
Median arcuate ligament syndrome (MALS) is a rare disorder caused primarily by compression of the celiac trunk by the median arcuate ligament (MAL). This disorder typically results in patients presenting with bloating, weight loss, nausea, vomiting, and abdominal pain. The MALS diagnosis is one of exclusion, as the disorder has no specific diagnostic criteria. Imaging modalities are often utilized to assist in making the diagnosis, such as ultrasound, computed tomography angiography (CTA), and magnetic resonance angiography (MRA). These imaging modalities typically reveal a stenosed celiac artery with post-stenotic dilation in patients. This disorder is usually treated by dividing the MAL, thus relieving the compression of the celiac artery. The surgery may be done through either an open approach or a minimally invasive approach, which can be either laparoscopic or robot-assisted. Most patients respond well to this treatment, though certain factors that predict a poorer response to treatment include elderly age, a history of alcohol abuse, and psychiatric illness.
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Affiliation(s)
- Will Upshaw
- Medicine, Louisiana State University Health Sciences Center, Shreveport, USA
| | - John Richey
- Medicine, Louisiana State University Health Sciences Center, Shreveport, USA
| | - Gurjot Ravi
- Medicine, Ross University School of Medicine, Shreveport, USA
| | - Adrian Chen
- Medicine, Louisiana State University Health Sciences Center, Shreveport, USA
| | - Noah J Spillers
- Medicine, Louisiana State University Health Sciences Center, Shreveport, USA
| | - Shahab Ahmadzadeh
- Anesthesiology, Louisiana State University Health Sciences Center, Shreveport, USA
| | | | - Sahar Shekoohi
- Anesthesiology, Louisiana State University Health Sciences Center, Shreveport, USA
| | - Alan D Kaye
- Anesthesiology, Louisiana State University Health Sciences Center, Shreveport, USA
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Farina R, Galioto F, Castiglione D, Basile A. Combination between Dunbar Syndrome and May-Thurner Syndrome: A Rare Case Report. J Med Ultrasound 2023; 31:238-241. [PMID: 38024998 PMCID: PMC10668899 DOI: 10.4103/jmu.jmu_27_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2022] [Revised: 04/01/2022] [Accepted: 04/12/2022] [Indexed: 12/01/2023] Open
Abstract
Dunbar syndrome (DS) and May-Thurner syndrome (MTS) are part of a group of rare vascular disorders known as "vascular compression syndromes." Dunbar's syndrome is caused by the median arcuate ligament of diaphragm, which, due to an abnormal course, causes celiac artery compression. MTS is caused by the left common iliac vein compression pushed against the spine by the right common iliac artery causing progressive flow congestion and leading to thrombosis. Ultrasound is the first-level examination for the diagnosis of these rare pathologies and allows to recognize vascular compressions and to obtain an estimate of stenosis degree. We describe a very rare case of DS and MTS combination in a young man with postprandial pain and left lower limb thrombosis.
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Affiliation(s)
- Renato Farina
- University of Catania, Department of Surgical and Medical Sciences Advanced Technologies GF Ingrassia, Catania, Italy
| | - Federica Galioto
- University of Catania, Department of Surgical and Medical Sciences Advanced Technologies GF Ingrassia, Catania, Italy
| | - Davide Castiglione
- University of Catania, Department of Surgical and Medical Sciences Advanced Technologies GF Ingrassia, Catania, Italy
| | - Antonio Basile
- University of Catania, Department of Surgical and Medical Sciences Advanced Technologies GF Ingrassia, Catania, Italy
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Cruz SM, Srinivas S, Wala SJ, Head WT, Michalsky MP, Aldrink JH, Diefenbach KA. Robotic-assisted minimally invasive surgery: Foregut procedures in pediatric patients. Semin Pediatr Surg 2023; 32:151256. [PMID: 36746111 DOI: 10.1016/j.sempedsurg.2023.151256] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Affiliation(s)
| | | | | | - W Taylor Head
- Nationwide Children's Hospital, Columbus, OH, USA; The Ohio State School of Medicine, Columbus, OH, USA
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Pitfalls and Traps in the Surgical Evaluation of Patients with Irritable Bowel Syndrome (IBS). J Gastrointest Surg 2022; 27:568-572. [PMID: 36456888 PMCID: PMC10065918 DOI: 10.1007/s11605-022-05544-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/02/2022] [Accepted: 10/08/2022] [Indexed: 12/03/2022]
Abstract
BACKGROUND Irritable bowel syndrome (IBS) is a complex disorder involving a variety of severe life-altering symptoms and yet-to-be-discovered biologic mechanisms. Patients with IBS are often referred to gastroenterologists who initiate a work-up to rule several potential confounding disease processes. This work-up often involves a consult with a general and/or vascular surgeon to determine if their IBS-like symptoms have an anatomic or surgical etiology. Potential concurrent problems may include the discovery of points or angulations at which gastrointestinal flow is impaired, median arcuate ligament syndrome/angulation, superior mesenteric syndrome/compression, the incidental finding of intestinal malrotation, and others. Once these diagnoses are entertained and/or documented in a patient's chart, "anchoring" on the diagnosis can lead to the belief that their IBS-like symptoms are due to a well-defined, operatively treatable anatomic condition. METHODS In this piece, we will breakdown the potential pitfalls in communicating, advising, and caring for patients with IBS-like symptoms presenting for surgical consultation. RESULTS Discussion points are offered with the goal of avoiding unnecessary operations even when faced with compelling anatomic evidence, a highly motivated patient, and a desperate and persuasive family. CONCLUSION Patients suffering from IBS presenting for surgical consultation with a defined anastomotic abnormality that may or may not be related to their symptoms represent a major challenge for surgeons. A multidisciplinary team approach can be useful to avoid unindicated surgery in these patients.
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