Dh. Balaban et al., MEDIAN ARCUATE LIGAMENT SYNDROME - A POSSIBLE CAUSE OF IDIOPATHIC GASTROPARESIS, The American journal of gastroenterology, 92(3), 1997, pp. 519-523
The median arcuate ligament syndrome (MALS) is characterized by abdomi
nal pain, nausea, and vomiting attributed to compression of the celiac
axis by a fibrous band (the median arcuate ligament) connecting the d
iaphragmatic crura. The pathophysiologic origin of these symptoms is n
ot clearly understood. Theories invoking either a neurogenic or vascul
ar origin for the clinical features associated with MALS have been pro
posed, but objective evidence to support these theories is lacking. We
describe the clinical course and gastric myoelectrical features of a
patient with postprandial epigastric pain, weight loss, gastroparesis,
and gastric dysrhythmias in whom a diagnosis of MALS was established.
Surgical decompression of the celiac axis in our patient resulted in
resolution of abdominal pain, return to a full diet within 4 weeks wit
hout nausea or vomiting, improvement in radionuclide gastric emptying,
and restoration of the gastric electrical rhythm to a normal 3 cycle/
min conduction rate. This is the first demonstration of altered gastri
c myoelectrical activity in a patient with MALS. The regularization of
the gastric electrical rhythm in our patient after surgical decompres
sion of the celiac axis would support a neurogenic basis for the sympt
oms associated with MALS. MALS should be excluded in patients with idi
opathic gastroparesis and unexplained epigastric pain.