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Dunbar syndrome

Dunbar syndrome



Overview

Median arcuate ligament syndrome (MALS) refers to a condition that happens when the median arcuate ligament in your chest presses against your celiac artery and nearby nerves (celiac plexus).

Your median arcuate ligament is shaped like an arch and goes around your aorta. Your aorta sends blood from your heart to the rest of your body, and your celiac artery is a major branch of your aorta.

Normally, your median arcuate ligament sits above your celiac artery. In MALS, your ligament is lower than usual. When it presses on your celiac artery, the pressure keeps blood from flowing through your celiac artery. It may also put pressure on nearby nerves.

When that happens, you develop pain in your upper abdomen that comes on after you eat. The pain may be so intense that you start avoiding food. Other names for MALS are:

Celiac artery compression syndrome

Celiac axis compression syndrome

Dunbar syndrome

Symptoms

Upper abdominal pain that happens after you eat is the first symptom of MALS. The pain may be so intense that you’re afraid to eat for fear that food will trigger symptoms. Other symptoms are:

Bloated stomach

Diarrhea

Nausea and vomiting

Unexplained weight loss of 20 pounds or more

Causes

The exact cause of median arcuate ligament syndrome, also called MALS, is not known.

Risk factors

Because the cause of MALS is poorly understood, the risk factors are unclear. Median arcuate ligament syndrome is more common in adults than in children. It also is more common among women than among men.

MALS also has been seen in identical twins, so genetics may play a role.

Some people have developed median arcuate ligament syndrome after pancreatic surgery or blunt injury to the upper stomach area.

Complications

A complication of median arcuate ligament syndrome, also called MALS, is long-term pain, especially after meals. The pain can lead to a fear of eating and significant weight loss. The pain and related depression or anxiety can greatly impact quality of life. MALS symptoms may be vague. The symptoms can be similar to those of other conditions. It may take some time to get an accurate diagnosis.

Diagnosis

To diagnose median arcuate ligament syndrome, also called MALS, a healthcare professional examines you and asks questions about your symptoms. The healthcare professional may hear a whooshing sound, called a bruit, when listening to your stomach with a stethoscope. The sound may occur when a blood vessel is narrowed.

Tests

Because many conditions can cause stomach pain, you usually have many tests to find the cause and rule out other possible conditions.

Tests to diagnose median arcuate ligament syndrome may include:

Blood tests. These tests are done to check for health conditions involving the liver, pancreas, kidneys and other parts of the body. A complete blood cell count shows the level of white and red blood cells. A high white blood cell count can mean there's an infection.

Ultrasound of the abdomen. This test uses sound waves to see how blood is flowing through the blood vessels. It can show if the celiac artery is compressed, especially when breathing in and out deeply.

Upper endoscopy. This procedure also is called esophagogastroduodenoscopy, known as an EGD. It's done to see the esophagus, stomach and upper part of the small intestine. During an EGD, a doctor guides a long, flexible tube with a camera on the end down the throat after applying numbing medicine. Also, tissue samples, called biopsies, can be removed for lab tests.

Gastric emptying studies. Pressure on the celiac artery can slow the rate of stomach emptying. These tests can show how fast the stomach empties its contents. Slow or delayed emptying may be caused by other medical conditions.

Magnetic resonance imaging (MRI). An MRI uses magnets and radio waves to make detailed images of the body area being studied. Sometimes, dye, called contrast, is given by IV. The dye show how blood moves through the arteries. This is called a magnetic resonance angiogram, also known as an MRA.

Abdominal computerized tomography (CT). A CT scan uses X-rays to create cross-sectional images of parts of the body. This test can show whether the celiac artery is narrowed or blocked. A dye, called contrast, may be given by IV. The dye helps blood vessels show up more clearly on the test images. When dye is used, the test is called a computerized tomography angiogram.

Celiac plexus block. Numbing medicine is injected into the nerves that sit on each side of the celiac artery. The numbing medicine lasts for several hours. This treatment mimics what happens during surgery to treat MALS. This test is often used to learn who may do well with MALS surgery.

Treatment

Surgery is the only treatment for median arcuate ligament syndrome, also called MALS. Surgery for MALS can improve or reduce symptoms in most people.

The most common surgical treatment is median arcuate ligament release, also called decompression. It's usually done as an open surgery through a cut in the belly area. Sometimes it is done using a camera and small instruments passed through several smaller openings. This is called laparoscopic surgery.

During decompression surgery, the surgeon cuts away parts of the median arcuate ligament. This reduces pressure on the celiac artery and nerves. The surgeon removes the nerves around the celiac artery and its branches. Bundles of nerves on each side of the celiac artery also may be removed.

Some people with MALS also may need surgery to repair or replace a blocked celiac artery and restore blood flow.

If you have MALS release surgery, you usually stay in the hospital for 2 to 3 days. You may have an ultrasound or a CT scan about a month after surgery to make sure that blood flow is fully restored. You may need to see a nutritionist to help with returning to a healthy diet. This is particularly helpful if you have not been eating or have lost a lot of weight.

Type of Doctor Department : Gastroenterologists. 

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