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Case report
Median arcuate ligament syndrome in a patient with frontal lobe syndrome
  1. Sri Lakshmi Kanthan Pandian,
  2. Saravana Sanniyasi,
  3. Sanjana Ravindra and
  4. Narayanan D Cunnigaiper
  1. General Surgery, Sri Ramachandra Medical College and Research Institute, Chennai, Tamil Nadu, India
  1. Correspondence to Dr Sri Lakshmi Kanthan Pandian; drsri1992{at}


A boy aged 19 years presented to emergency room with severe postprandial upper abdominal pain and recent significant weight loss, with history of decompressive craniotomy for post-traumatic frontal lobe haemorrhage. CT scan revealed an acute indentation of coeliac artery with high-grade stenosis and post-stenotic dilatation, diagnostic of median arcuate ligament syndrome (MALS). MALS, a diagnosis of exclusion, is identified using patient’s accurate symptomatic description. Exclusion of other causes of abdominal angina in a patient with frontal lobe syndrome was a challenging job, as they lack critical decision-making ability. Hence, the decision to proceed with the complex laparoscopic procedure was made by the patient’s parents and the surgeon, with the patient’s consent. Laparoscopic release of the median arcuate ligament resulted in relief of the patient symptoms much to the relief of his parents and the surgeon.

  • vascular surgery
  • gastrointestinal surgery

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  • Contributors SLKP involved in preoperative work-up and postoperative follow-up of the patient. SS and NDC were the primary surgeons. SR drawn diagrams for the manuscript and involved in manuscript publication work.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Patient consent for publication Obtained.

  • Provenance and peer review Not commissioned; externally peer reviewed.