Arcuate ligament syndrome, also called median arcuate ligament syndrome, is a condition that results in the celiac artery being compressed by the median arcuate ligament under the diaphragm. Symptoms of this disorder include abdominal pain, weight loss, nausea and vomiting. In some cases, patients might also experience abdominal bruit, an unusual rushing noise that occurs when blood speeds past an obstructed artery. The condition is believed to affect more than 10 percent of the world's population, with about 1 percent reporting severe symptoms. Women are stricken more frequently than men, but any person 20-30 years old can suffer from this syndrome.
Along with painful side effects, people who have chronic arcuate ligament problems can experience serious complications. Gastroparesis as a side effect most often strikes women and is characterized by partial stomach paralysis that results in a slower-than-normal emptying of stomach contents. The connection between arcuate ligament syndrome and gastroparesis might result from unusual weight loss that resembles symptoms of anorexia nervosa. Aneurysm of certain arteries associated with the pancreas, duodenum and lower intestines can also afflict people who have this type of ligament condition and is a potentially life-threatening disorder.
To diagnose arcuate ligament syndrome confidently, health care workers must first rule out other conditions that have similar symptoms. By testing for — and excluding — other causes of celiac artery compression, physicians can begin to suspect problems with the arcuate ligament as the source of the affliction. Under the direction of a doctor, radiology technicians typically screen for the disorder with ultrasonography or magnetic resonance angiography. Following either of these procedures, technicians help doctors confirm the diagnosis using computerized systems such as computed tomography (CT), which creates a three-dimensional image of the affected area.
Treatment consists of several surgical procedures. Open separation of the median arcuate ligament in combination with extraction of the celiac ganglia is the most common form of surgery. If this approach fails to restore proper blood flow through the celiac artery, physicians might opt for celiac artery revascularization in the form of patch angioplasty or aortoceliac bypass surgery. A less invasive laparoscopic form of treatment might also produce successful artery decompression in some patients, but relapses can occur following the procedure.
The prognosis for patients who have arcuate ligament syndrome varies according to age, mental health and lifestyle. People who are 40-60 years old typically remain asymptomatic after receiving treatment, and younger patients exhibit a higher overall relapse rate. Factors such as drug or alcohol abuse, excessive weight loss and psychiatric conditions can also have a negative effect on patient recovery.
