LAUSR

Median arcuate ligament syndrome (MALS) occurs when the median arcuate ligament compresses the proximal coeliac trunk superiorly and creates an acute angulation in the artery. In some patients, this can result in chronic recurrent post-prandial epigastric pain as well as nausea and vomiting. The resulting coeliac artery has a hook-like or fish-hook appearance. Post-stenotic dilation is often seen, as if resembling a caught fish. Although originally diagnosed via catheter angiography, this can be demonstrated well on a sagittal reformat with CT Angiography. Median arcuate ligament syndrome is associated with aneurysm formation in the pancreaticoduodenal artery due to changes in collateral flow. The European Society of Vascular Surgery recently produced guidelines which included discussion of MALS. They state that external compression of the coeliac artery by the median arcuate ligament is a common, but mostly asymptomatic, finding. When causing symptoms of postprandial intestinal ischaemia, MALS is also known as the Dunbar syndrome. The existence of this disease is still controversial, and the diagnosis depends on elimination of other possible causes of abdominal pain.