Chronic Post-Prandial Epigastric Pain Associated with Median Arcuate Ligament Syndrome and Atherosclerosis of the Celiac Trunk in An Elderly Woman: A Case Report.

Abstract

BACKGROUND Post-prandial abdominal pain due to bowel ischemia can be caused by stenosis (atherosclerosis) or by compression of the arteries of the celiac axis. Median arcuate ligament syndrome (MALS) results from compression at the origin of the celiac trunk by the arcuate ligament. This report describes a 66-year-old woman with chronic post-prandial epigastric pain associated with atherosclerosis of the celiac trunk, managed with angioplasty and stenting combined with MALS. CASE REPORT A 66-year-old female patient with a history of dyslipidemia presented with chronic epigastric pain with post-prandial episodes for 4 years. Two years before the admission, her pain increased with meals and was not relieved by empirical treatment for gastritis. An esophagogastroduodenoscopy and colonoscopy showed chronic gastritis. One year later, a resection of the gastric submucosal tumor was performed, without improving her symptoms. In this presentation, the prompt computed tomography revealed hook-shaped stenosis of the celiac trunk and mild post-stenosis dilatation, highly suggestive of MALS. However, the patient refused to undergo surgery despite the benefit of this intervention. Concurrently, moderately severe atherosclerosis of the celiac trunk was detected during intra-vessel imaging. The patient was treated individually and underwent angioplasty with stenting. At a 5-month follow-up, the patient's condition was stable and she had no gastrointestinal symptoms. CONCLUSIONS Due to the low prevalence and nonspecific symptoms of MALS, physicians should be highly suspicious of this disease, especially in patients with post-prandial abdominal pain. Angioplasty and stenting can be performed in selected patients with MALS and atherosclerosis of the celiac trunk.