Median arcuate ligament syndrome (Dunbar syndrome)

Case contributed by Dr Ali Basim

Presentation

Chronic, recurrent epigastric abdominal pain, especially postprandial and weight loss

Patient Data

Age: 20 years
Gender: Female

Doppler study of celiac artery : 

An expiratory exam shows a velocity of 162 cm/s.

During inspiration, the following features are evident:

  • increased systolic velocity (280 cm/s) with aliasing artifact
  • increased end-diastolic velocity (90 cm/s).
  • increased celiac artery compression (indentation of upper aspect)
  • large deflection angle between inspiration and expiration

Doppler ultrasound features suggest celiac axis compression.

CT scan performed in the mid position between inspiration and expiration:

  • asymmetric stenosis of celiac trunk origin due to compression of the superior aspect of the artery by the arcuate ligament
  • post-stenotic dilatation

Case Discussion

The following should be considered if celiac artery compression syndrome is suspected:

  • it is a rare condition
  • in this case, it presented as chronic postprandial abdominal pain
  • narrowing of the celiac trunk at the diaphragm is non-specific and commonly seen in asymptomatic patients
  • imaging findings should be correlated with the clinical history
  • treatment is with surgical decompression

Laparoscopic surgical decompression was done for this patient with symptomatic improvement after surgery.

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