Videolaparoscopic management of arcuate ligament syndrome in pediatric patients

Median arcuate ligament syndrome, which is characterized by postprandial pain, occurs as a result of the compression of the celiac trunk by the ligament. It is a rare pathology in pediatric patients. We present the case of a 14-year-old girl with recurrent abdominal pain. Ultrasound examination showed an increase in celiac trunk flow rate with flow reversal, while CT angiography demonstrated compression. It was surgically managed by dividing the arcuate ligament through videolaparoscopy. Symptoms disappeared right after surgery and did not reappear in the 24-month follow-up. The arcuate ligament is a fibrous band located at the level of the diaphragmatic crus. The fact that the celiac trunk originates at the supradiaphragmatic aorta makes the ligament exert compression during expiration, with transitory distal ischemia. Diagnosis is achieved through Doppler ultrasonography of the celiac trunk or CT angiography, among others. Surgical management involves dividing the arcuate ligament. This syndrome should be considered in the presence of recurrent abdominal pain. The laparoscopic route is the treatment approach suggested.