Ligament syndrome causes man to have abdominal pain for 4 months

Ho Chi Minh City – Mr. Trung, 70 years old, had been experiencing dull pain in the upper abdominal area and on the left side for 4 months. Doctors discovered he had a rare medial arch ligament syndrome.

Previously, Mr. Trung thought he had a stomach ache and took medication to relieve the symptoms, so he didn't go for a check-up. Later, his pain worsened, and tests and scans didn't detect any illness, so he went to Tam Anh General Hospital in Ho Chi Minh City for examination.

On January 31st, Dr. Nguyen Anh Dung, Head of the Cardiovascular and Thoracic Surgery Department at the Cardiovascular Center, stated that upper abdominal pain is often a symptom of digestive diseases (stomach, liver, gallbladder, pancreas). However, clinical and imaging diagnoses did not reveal any damage to these areas in Mr. Trung. A contrast-enhanced abdominal CT scan revealed an 85% stenosis at the origin of the celiac artery – a major artery supplying blood to the liver, spleen, stomach, esophagus, pancreas, and duodenum.

Arterial stenosis is usually caused by atherosclerosis, narrowing from within the vessel lumen, external compression, trauma, accidents, or other medical procedures. However, Mr. Trung did not have atherosclerosis, trauma, or any medical interventions. The doctor diagnosed him with medial arch ligament syndrome (also known as celiac artery compression syndrome), which compresses the celiac artery and celiac sympathetic ganglia. This is the cause of his abdominal pain, according to Dr. Dung.

Dr. Tran Quoc Hoai, Specialist in Cardiovascular and Thoracic Surgery, Cardiovascular Center, explains that the chest and abdomen are separated by the diaphragm. The aorta runs from the chest through the diaphragmatic artery opening to the abdomen, branching off to supply blood to various organs. In a normal person, the ligaments are located high up, and the aorta passes through the ligaments, down to the abdomen, and branches into the celiac artery. In cases of medial arch ligament syndrome, the celiac artery is tightly constricted by the ligaments, and over time, the narrowed area gradually widens (due to increased blood flow velocity after the narrowing, creating pressure on the vessel wall).

Mr. Trung has a 7 mm aneurysm behind the narrowed area. Without early intervention, the aneurysm risks progressing and threatening the patient's life.

The surgeon performs a laparoscopic surgery by making an incision above the navel and inserting an endoscope to access the patient's diaphragm. With the assistance of a laparoscopic camera, the team cuts the medial arch ligament to create an opportunity for the celiac artery to dilate. After two hours, the surgery is complete, and the celiac artery's size returns to normal.

Doctor Dung (right) and his surgical team cut the ligaments tightly binding the celiac artery for a patient. Photo: Tam Anh Hospital — Doctor Dung (right) and his surgical team cut the ligaments tightly binding the celiac artery for a patient. Photo: *Tam Anh Hospital*

Median ligament syndrome commonly presents with symptoms including abdominal pain (especially after eating or exercising), nausea, vomiting, diarrhea, bloating, and unexplained weight loss. Anyone can develop this syndrome. The symptoms are vague, making diagnosis difficult.

According to Dr. Dung, surgery to release the medial arch ligament is the only treatment for this syndrome. Patients experience immediate symptom improvement after surgery and require regular follow-up appointments to monitor the recovery of blood flow through the celiac artery.

Thu Ha

* The names of the characters in the article have been changed.

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