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Median Arcuate Ligament Syndrome With Concomitant Hyperkinetic Gallbladder.

Josiah T Hardy1, Benjamin O Brandeis1, Anahita Shiva1

  • 1University of Maryland School of Medicine, Baltimore, MD, USA.

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Median arcuate ligament syndrome (MALS) causes abdominal pain due to celiac artery compression. Patients with hyperkinetic gallbladder dyskinesia (HGBD) may also have MALS, and surgery offers symptom relief.

Keywords:
hyperkinetic gallbladder dysmotilitymedian arcuate ligament syndromevascular surgery

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Area of Science:

  • Gastroenterology
  • Vascular Surgery
  • Abdominal Imaging

Background:

  • Median arcuate ligament syndrome (MALS) involves celiac artery compression, causing epigastric and postprandial pain.
  • Hyperkinetic gallbladder dyskinesia (HGBD), characterized by a gallbladder ejection fraction (GBEF) over 80%, shares overlapping symptoms with MALS.
  • Differentiating these conditions is crucial for effective patient management.

Purpose of the Study:

  • To investigate the prevalence of HGBD in patients surgically treated for MALS.
  • To evaluate the clinical presentation and surgical outcomes in patients with both HGBD and MALS.

Main Methods:

  • Retrospective chart review of patients who underwent MALS surgery.
  • Identification of patients with a history of HGBD based on GBEF measurements.
  • Analysis of patient demographics, symptoms, comorbidities, and surgical outcomes.

Main Results:

  • Six out of 69 patients (8.7%) undergoing MALS surgery also had HGBD (GBEF >80%).
  • The cohort was predominantly female (83.3%) with a mean age of 31 years.
  • All patients reported symptomatic improvement after MALS surgery, and most had multiple vascular compression syndromes.

Conclusions:

  • Patients with HGBD should be evaluated for MALS due to overlapping symptoms.
  • Surgical decompression for MALS is an effective treatment for patients with coexisting HGBD.
  • Early diagnosis and surgical intervention can significantly improve quality of life.