MEDIAN ARCUATE LIGAMENT SYNDROME (DUNBAR SYNDROME) AS A MULTIDISCIPLINARY PROBLEM. CLINICAL OBSERVATION AND LITERATURE REFERENCE

Introduction. Median arcuate ligament syndrome (MALS, Dunbar syndrome) is a rare vascular compression syndrome caused by extravascular compression of the celiac trunk (CT) and celiac plexus by the median arcuate ligament of the diaphragm and is one of the causes of chronic abdominal ischemia and neuropathic pain syndrome. Clinical observation. A woman, 36 years old, was hospitalized with complaints of abdominal pain of moderate intensity, diarrhea up to 10 times a day, weight loss of 11 kg over the past year. Inflammatory bowel disease, gluten enteropathy, lymphoma of the small intestine, malabsorption syndrome, pathology of the endocrine system was excluded. Abdominal high-resolution computed tomography (HRCT) angiography was performed. Signs of extravascular compression of CT up to 90% with a thickened median arcuate ligament with the formation of a U-shaped deformation were revealed. Laparoscopic decompression surgery was performed with simultaneous transluminal angioplasty, which led to a decrease in compression and disappearance of clinical symptoms. After 18 months, clinical improvement persisted, diarrhea disappeared. HRCT angiography and ultrasound duplex examination (USDE) showed sufficient blood flow in the CT system. During the follow-up period, the patient had moderate neuropathic pain and anxiety and depressive disorders requiring appropriate correction. Conclusion. The diagnostic and therapeutic approach to MALS should be patient-centered and requires the involvement of a team of specialists. Laparoscopic decompression is an effective treatment and can provide immediate symptoms relief. The results of the intervention can be assessed by HRCT angiography and USDE (methods supplementing each other). Correction of neuropathic pain syndrome and anxiety-depressive disorder is of great importance for improving the patient's quality of life.