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Identical anatomy, different symptoms: a comparative case study of median arcuate ligament syndrome in monozygotic twins
  1. Lakmali Anthony1,
  2. Madeline Gillies2 and
  3. Iman Bayat3
  1. 1Vascular Surgery, Northern Health NCHER, Epping, Victoria, Australia
  2. 2Western Health, Footscray, Victoria, Australia
  3. 3Vascular Surgery, Northern Hospital, Epping, Victoria, Australia
  1. Correspondence to Dr Lakmali Anthony; lakmali.anthony610{at}gmail.com

Abstract

Median arcuate ligament syndrome (MALS) is a rare clinical entity arising from the extrinsic compression of the coeliac axis by the median arcuate ligament. In this report, we detail a unique presentation involving monozygotic twins, both of whom demonstrated anatomical extrinsic compression of the coeliac axis by the median arcuate ligament. Intriguingly, only one twin manifested clinical symptoms consistent with MALS, despite comparable anatomical compression of the coeliac axis observed in both. This case highlights the potential interplay of a genetic or anatomical predisposition to coeliac axis compression and secondary, possibly environmental, factors that lead to the development of clinical symptoms. In this report, we explore various determinants potentially influencing symptomatology in MALS and advocate for the publication of similar case studies to further elucidate this rare condition.

  • Gastrointestinal system
  • General surgery
  • Vascular surgery

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Footnotes

  • Contributors LA performed the literature review and wrote the manuscript. MG drew figure 1. IB was the supervisor and editor of the manuscript.

  • 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.

  • Case reports provide a valuable learning resource for the scientific community and can indicate areas of interest for future research. They should not be used in isolation to guide treatment choices or public health policy.

  • Competing interests None declared.

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