From the Research
Introduction
Minimal narrowing of the coeliac axis at the median arcuate ligament is a finding that can be observed on computed tomography angiography (CTA) images. This condition is often associated with the median arcuate ligament syndrome (MALS), a rare disorder caused by extrinsic compression of the coeliac artery by the median arcuate ligament.
Clinical Significance
The clinical significance of minimal narrowing of the coeliac axis at the median arcuate ligament is still a topic of debate. According to a study published in the Journal of Vascular Surgery 1, the normal anatomy of the coeliac axis on CT angiography images demonstrates that it exits the aorta downward and then shifts upward, which can be misinterpreted as a hook or J shape resulting from external compression. However, another study published in the Journal of Vascular Surgery 2 suggests that MALS can cause significant symptoms, including postprandial abdominal pain, nausea, vomiting, and unintentional weight loss.
Diagnostic Considerations
The diagnosis of MALS is based on a combination of clinical symptoms and radiological findings. A study published in Langenbeck's Archives of Surgery 3 found that a definite diagnosis of MALS can be achieved by lateral aortography of the visceral aorta and its branches during inspiration and expiration. Another study published in the Canadian Association of Radiologists Journal 4 found that multidetector computed tomography (MDCT) is a useful tool for diagnosing MALS, with characteristic findings including focal narrowing of the proximal coeliac artery and a hooked appearance of the narrowed segment.
Treatment Options
Treatment options for MALS include open surgical therapy, laparoscopic decompression, and endovascular treatment. A study published in Langenbeck's Archives of Surgery 3 found that open surgical therapy is a safe and reliable procedure with no mortality and low morbidity. However, another study published in the Journal of Vascular Surgery 2 suggests that endovascular treatment with percutaneous transluminal angioplasty and insertion of a stent may not be effective in the long term and may require open procedures.
Differential Diagnosis
The differential diagnosis of MALS includes other causes of abdominal pain, such as functional abdominal pain syndrome. A case report published in Cureus 5 highlights the importance of considering MALS in the differential diagnosis of patients with unexplained gastrointestinal symptoms.
Conclusion
In conclusion, minimal narrowing of the coeliac axis at the median arcuate ligament can be a finding associated with MALS, but its clinical significance is still debated. A combination of clinical symptoms and radiological findings is necessary for diagnosis, and treatment options include open surgical therapy, laparoscopic decompression, and endovascular treatment. It is essential to consider MALS in the differential diagnosis of patients with unexplained gastrointestinal symptoms.
Treatment
- Open surgical therapy: decompression of the coeliac axis and reconstruction of the coeliac artery
- Laparoscopic decompression: decompression of the coeliac axis
- Endovascular treatment: percutaneous transluminal angioplasty and insertion of a stent
Dosing Information
No specific dosing information is relevant to this condition.
Caveats
- MALS is a rare disorder, and diagnosis can be challenging
- Endovascular treatment may not be effective in the long term and may require open procedures
- Laparoscopic decompression may not be adequate for all cases
- Continuing to reassess the clinical picture of patients labeled with functional abdominal pain syndrome is essential to diagnose MALS.