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Celiac artery compression after a gastric bypass.

Nathan G Richards1, Richard F Neville, Anton N Sidawy

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Summary

Median arcuate ligament (MAL) syndrome, or celiac artery compression, can occur after gastric bypass surgery. This case highlights successful laparoscopic treatment for MAL syndrome presenting as postprandial pain following weight loss.

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Area of Science:

  • Vascular Surgery
  • Gastroenterology
  • Bariatric Surgery

Background:

  • Median arcuate ligament (MAL) syndrome involves celiac artery compression, causing symptoms like postprandial abdominal pain.
  • Diagnosis typically involves imaging studies to confirm celiac artery impingement.

Observation:

  • A patient developed postprandial pain and nausea after successful Roux-en-Y gastric bypass and significant weight loss.
  • Imaging confirmed celiac artery compression, with dynamic ultrasound showing elevated velocities during expiration.

Findings:

  • A laparoscopic MAL release with division of the celiac plexus was performed.
  • The patient remained asymptomatic 10 months postoperatively, indicating successful treatment.

Implications:

  • This case suggests celiac artery compression should be considered in patients experiencing postprandial abdominal pain after bariatric surgery.
  • Laparoscopic MAL release is a viable treatment option for this rare complication.