Combined Treatment of Multiple Splanchnic Artery Aneurysms Secondary to Median Arcuate Ligament Syndrome: A Case Study and Review of the Literature

Patient: Female, 45-year-old Final Diagnosis: Multiple splanchnic artery aneurysms secondary to median arcuate ligament syndrome • occlusion of the coeliac trunk • significant stenosis of the superior mesenteric artery Symptoms: Abdominal pain • postprandial abdominal pain • weight loss Medication:— Clinical Procedure: Aorto-hepatic bypass • endovascular aneurysm embolization Specialty: Surgery Objective: Rare disease Background: Median arcuate ligament syndrome (MALS) is a rare and often misdiagnosed condition affecting about 0.4% of the population, typically ages 20–50 years old, and more frequently females. Caused by the compression of the celiac artery and adjacent nervous structures by the median arcuate ligament, it is typically manifested by postprandial abdominal pain, nausea or vomiting, and loss of weight. This condition also results in compensatory increased blood flow in peripancreatic arcades, facilitating formation of true aneurysms of the visceral vessels. Case Report: A 45-year-old woman with hypertension and left inferior renal pole cysts was referred to our department due to chronic, recurrent postprandial abdominal pains, nausea, and weight loss of approximately 15 kg in 1 year. A computed tomography (CT) scan demonstrated complete occlusion of the celiac trunk, significant stenosis of the superior mesenteric artery, and multiple aneurysms up to 17 mm in collateral circulatory vessels. Surgical decompression of the median arcuate ligament was performed and venous bypass was implanted between the aorta and the common hepatic artery, resulting in restoration of proper blood in the visceral circulation. Subsequently, 2 endovascular embolizations of visceral aneurysms were successfully performed. In the 48-month follow-up period, there was resolution of symptoms and no aneurysm formation was observed. Conclusions: Endovascular methods should be the treatment of choice in patients with splanchnic artery aneurysms. However, in patients with multiple aneurysms secondary to MALS, arterial reconstruction may be considered prior to performing an endovascular procedure to restore physiological blood flow in the visceral circulation.