Objective: Unusual clinical course Background: Post-prandial abdominal pain due to bowel ischemia can be caused by stenosis (atherosclerosis) or by com¬pression of the arteries of the celiac axis. Median arcuate ligament syndrome (MALS) results from compres¬sion at the origin of the celiac trunk by the arcuate ligament. This report describes a 66-year-old woman with chronic post-prandial epigastric pain associated with atherosclerosis of the celiac trunk, managed with angio¬plasty and stenting combined with MALS. Case Report: A 66-year-old female patient with a history of dyslipidemia presented with chronic epigastric pain with post-prandial episodes for 4 years. Two years before the admission, her pain increased with meals and was not re¬lieved by empirical treatment for gastritis. An esophagogastroduodenoscopy and colonoscopy showed chron¬ic gastritis. One year later, a resection of the gastric submucosal tumor was performed, without improving her symptoms. In this presentation, the prompt computed tomography revealed hook-shaped stenosis of the ce¬liac trunk and mild post-stenosis dilatation, highly suggestive of MALS. However, the patient refused to un¬dergo surgery despite the benefit of this intervention. Concurrently, moderately severe atherosclerosis of the celiac trunk was detected during intra-vessel imaging. The patient was treated individually and underwent an¬gioplasty with stenting. At a 5-month follow-up, the patient’s condition was stable and she had no gastroin¬testinal symptoms. Conclusions: Due to the low prevalence and nonspecific symptoms of MALS, physicians should be highly suspicious of this disease, especially in patients with post-prandial abdominal pain. Angioplasty and stenting can be performed in selected patients with MALS and atherosclerosis of the celiac trunk.
