Median arcuate ligamentum syndrome: Four case reports

BACKGROUND Median arcuate ligamentum syndrome (MALS) is a disease entity with unclearpathogenesis. If it is not considered in advance, the clinical diagnosis of thedisease is very difficult because patients complain of digestive discomfortincluding pain. However, this characteristic is not specific to MALS. There havebeen no studies to assist in making a quick diagnosis. The aim of this case serieswas to recognize that MALS must be considered as a differential factor in thecause of abdominal pain.CASE SUMMARYWe described cases in which four patients complained of abdominal pain over along period but in whom a diagnosis of MALS could not be made. If the gastroen-terologist does not take into account abdominal pain in advance, the patient isconsidered an asymptomatic gallstone patient and has their gallbladder removeddespite imaging evaluation. The patient may also be considered a psychiatricpatient and may be administered psychiatric drugs over a long period. In all fourcases in this report, the patients experienced abdominal pain. In three cases, thediagnosis was possible by the clinician’s judgment considering both clinicalsymptoms and imaging techniques shortly after the onset of symptoms. However,in one case that lasted over 20 years, a clear diagnosis was not possible. Even aftercomplaining of colicky pain and performing a cholecystectomy, the diagnosis wasmade only after the symptoms persisted. In all four cases, the symptoms wererelieved by neuromodulators.CONCLUSIONMALS is a rare disease and it is easy to miss because it is not malignant, butpatients can suffer from pain over a long period. For the accurate diagnosis of apatient complaining of abdominal pain, the diagnosis must be differentiated. Inaddition, as there are asymptomatic patients, patients who need treatment shouldbe carefully selected, and improvement with medical treatment can be expected.Large-scale studies are also needed.