Can May-Thurner syndrome (MTS) cause chronic abdominal pain?

May-Thurner Syndrome as a Cause of Chronic Abdominal Pain

May-Thurner syndrome (MTS) is not typically a primary cause of chronic abdominal pain, as its main symptoms involve the lower extremities due to venous compression in the pelvis. While MTS can cause significant morbidity, its clinical presentation primarily includes left leg swelling, pain, and deep vein thrombosis rather than abdominal symptoms.

Understanding May-Thurner Syndrome

May-Thurner syndrome is a vascular condition characterized by:

• Compression of the left common iliac vein by the right common iliac artery against the lumbar spine 1
• Primarily affects venous return from the left lower extremity
• Can lead to venous stasis, thrombosis, and related complications

Typical Clinical Presentation of MTS

• Left leg swelling and edema
• Lower extremity pain or claudication
• Deep vein thrombosis (DVT) of the left lower extremity
• In severe cases, pulmonary embolism 1, 2

Relationship to Abdominal Pain

MTS does not typically present with abdominal pain as a primary symptom. When evaluating chronic abdominal pain, other more common causes should be considered first:

1. Mesenteric ischemia - Particularly in patients with risk factors such as atherosclerotic disease, which presents with postprandial pain, fear of eating, and weight loss 3

2. Chronic intestinal dysmotility - Presents with abdominal pain, distension, bloating, early satiety, nausea, and vomiting 3

3. Constipation-related pain - Typically presents as colicky or cramping abdominal pain that worsens with eating and improves after bowel movements 4

Diagnostic Approach for Suspected MTS

If MTS is suspected as a potential contributor to symptoms:

• Color Doppler and duplex Doppler ultrasound can identify deep vein thrombosis and vascular changes typical of MTS 1
• CT venography (CTV) of the abdomen and pelvis can identify stenosis, occlusion, collaterals, and edema related to venous obstruction 3
• Catheter venography with intravascular ultrasound (IVUS) is usually performed for definitive diagnosis before intervention 3

Management Options

For confirmed MTS with symptoms:

• Anticoagulation therapy alone is often insufficient as it doesn't address the mechanical compression 2
• Endovascular management with stent placement is considered front-line treatment for symptomatic MTS 2, 5
• The goal of treatment is to reduce symptoms and prevent complications such as DVT and pulmonary embolism 5

Key Considerations

• MTS is often underdiagnosed and should be considered in patients with unexplained left lower extremity symptoms 6
• Complications of endovascular treatment include stent migration, as reported in rare cases 7
• If chronic abdominal pain is the primary complaint, other causes should be investigated before attributing symptoms to MTS

Alternative Diagnoses to Consider

When evaluating chronic abdominal pain:

1. Mesenteric ischemia - Consider in patients with postprandial pain and weight loss, especially with atherosclerotic risk factors 3

2. Median arcuate ligament syndrome - Can cause celiac artery compression and abdominal pain, especially postprandial 3

3. Chronic intestinal dysmotility - Consider in patients with abdominal pain, distension, and altered bowel habits 3

4. Constipation-related pain - Evaluate for improvement after bowel movements 4

In summary, while MTS is an important vascular condition that can cause significant morbidity through lower extremity symptoms and complications, it is not typically associated with chronic abdominal pain as a primary manifestation.