MEDIAN ARCUATE LIGAMENT COMPRESSION SYNDROME IN MONOZYGOTIC TWINS

Twin 27-year-old women had symptomatic mesenteric ischemia caused by m edian arcuate Ligament compression. Arteriography demonstrated severe celiac artery stenosis in one twin, celiac artery occlusion in the oth er, and proximal superior mesenteric artery narrowing with retrograde filling from a meandering mesenteric artery in both. Division of the l igament and direct celiac artery revascularization completely relieved symptoms in both patients. Median arcuate ligament compression of the celiac and superior mesenteric arteries can result in mesenteric isch emia. Documentation of this unusual syndrome in monozygotic twins sugg ests that the responsible anatomic relationships are congenital.