Exercise-related abdominal pain as a manifestation of the median arcuate ligament syndrome

Abdominal pain related to exercise, often loosely referred to as 'stitch', is not uncommon, particularly among participants in sports that involve running. The cause of this typically transient pain is poorly understood with several aetiologies proposed including diaphragmatic ischaemia (&;lt;citeref rid="b1"&;gt;1&;lt;/citeref&;gt;,?&;lt;citeref rid="b2"&;gt;2&;lt;/citeref&;gt;). Other gastrointestinal symptoms that are common during prolonged or high-intensity exercise include nausea, diarrhoea and gastrointestinal bleeding (&;lt;citeref rid="b3"&;gt;3&;lt;/citeref&;gt;,?&;lt;citeref rid="b4"&;gt;4&;lt;/citeref&;gt;). These symptoms are also usually transient and are thought to protect against critical organ damage by promoting cessation of exercise. Decreased gastrointestinal blood flow, increased motility and altered neuroendocrine modulation are postulated disease mechanisms (&;lt;citeref rid="b3"&;gt;3&;lt;/citeref&;gt;). We report here a case of an elite runner with exercise-related severe abdominal pain and diarrhoea related to compression of the coeliac axis by the median arcuate ligament. Complete symptom relief was achieved with surgical division of the constricting ligament. The clinical characteristics and pathogenesis of coeliac axis compression syndrome are discussed.     

Laparoscopic management of median arcuate ligament syndrome

Median arcuate ligament syndrome is a rare disorder resulting from luminal narrowing of the celiac trunk. The classic management of median arcuate ligament syndrome involves the surgical division of the median arcuate ligament fibers in order to decompress the celiac trunk. This has traditionally required an upper midline incision. A few authors have described a successful laparoscopic release of celiac artery compression syndrome. Laparoscopy provides a less invasive, but equally effective method for decompressing the celiac trunk.     

The laparoscopic approach in the median arcuate ligament syndrome: report of a case

A malposition of the median arcuate ligament (MAL) is a rare entity causing the celiac axis compression syndrome (CACS), first described by Harjola in 1963. The presence of anomalous fibrous diaphragmatic bands of the diaphragm compresses the celiac axis, especially during the expiration. In this report we present the fourth case in literature that was ever successfully treated by laparoscopy. A 38-year-old male presented with a history of intermittent epigastric pain, 15 kg weight loss caused by inappetence and frequent diarrhoea, over a 5-year period. The clinical examination revealed only a loud systolic bruit in the epigastrium, with loss of intensity during deep inspiration. Suspecting CACS, a spiral CT angiography was requested. The CT demonstrated the MAL crossing anteriorly to the celiac artery (CA) and the sagittal and the tridimensional reconstructions demonstrated the CA narrowing due to compression, while the superior mesenteric artery (SMA) was normal. The MAL was laparoscopically divided, releasing the celiac axis. The surgical time was 130 minutes, without significant blood losses. At 3-months follow-up, the CT-scan demonstrated no evidence of CACS with complete recovery.     

Median arcuate ligament syndrome

Opinion statement Median arcuate ligament syndrome (MALS) can cause a range of symptoms, including abdominal pain, nausea, vomiting, and weight loss. Because all patients have some degree of celiac artery compression by the median arcuate ligament (MAL), it may be difficult to discern which patients have a pathologic compression. Based on the multiple theories of MALS etiology, it is unlikely that we know the true cause of this syndrome. In fact, there are many physicians who question the validity of the diagnosis of MALS. Before offering intervention for MALS, a thorough gastrointestinal evaluation should be performed, including consideration of diagnostic temporary percutaneous celiac ganglion block. Patients who are on chronic narcotics preoperatively have a lower likelihood of postoperative symptom relief and therefore should be evaluated by a pain specialist preoperatively. The most reliable treatment comprises open surgical treatment with division of the MAL, removal of surrounding celiac ganglion, evaluation of the celiac artery with pressure measurements or ultrasound, and celiac artery reconstruction if indicated. Laparoscopic and endovascular interventions are novel treatments and may be considered in select patients who cannot undergo an open surgical procedure.     

以腹痛为主要表现疾病的病因分析

目的增加对腹痛的病因认识,提高其诊断率。方法连续抽取以腹痛待查收入消化内科的住院病例124例进行病因、症状、体征、辅助检查的统计分析。结果以腹痛为主要临床表现的疾病病变部位,腹腔内器官占93．55％,腹腔外器官占6．45％,最常见的病因为胆囊炎、胆石症（占19．35％）。结论以腹痛为主要表现的疾病病因复杂,病情多变,应特别重视其早期诊断。     

以腹痛为主要表现的内科疾病临床分析

目的　增加对内科疾病导致腹痛的认识 ,提高其诊断率并探讨治疗方法。方法　连续抽取 94例以腹痛为主要表现的内科疾病的住院病例进行病因、症状、体征、辅助检查以及治疗的统计和分析。结果　以腹痛为主要表现的内科疾病病变部位 :腹腔内器官疾病占 90 4% ,腹腔外器官疾病占 9 6% ;其最常见病因为急性胃肠炎 (占19 1% )。结论　以腹痛为主要表现的内科疾病病因复杂 ,特征不典型 ,应重视其诊断及治疗     

以腹痛为主要表现的获得性免疫缺陷综合征临床分析

[目的]探讨以腹痛为主要表现的获得性免疫缺陷综合征(AIDS)的临床特征,以提高对该病的认识。[方法]对22例AIDS患者的临床资料进行回顾分析,并结合文献进行复习。[结果]全部患者均有腹痛(100%),其他主要症状为腹胀(77.3%)、腹泻(59.1%)、吞咽困难或吞咽疼痛(22.7%)、口腔炎或口腔真菌感染(18.2%)、纳差(72.7%)、乏力(68.2%)、不明原因发热(31.8%)、体质量减轻(40.9%)等,2例(9.0%)面部出现米糠样皮疹。胃镜下主要表现为胃黏膜充血水肿、糜烂,结肠黏膜主要表现为弥漫性或局限性充血水肿、糜烂或浅表溃疡等。[结论]AIDS以腹痛等消化系统症状为主要表现者比较多见,但临床表现无特异性,临床医务人员尤其是消化内科医师要不断提高对该病的认识,早诊早治,减少误诊。     

Celiac axis compression by median arcuate ligament on computed tomography among asymptomatic persons

Background/Aim  

Compression of celiac artery by median arcuate ligament (MAL) may cause abdominal symptoms. This study looked at the prevalence of this finding in asymptomatic persons.     

Recurrent abdominal pain as the sole manifestation of hereditary angioedema in multiple family members

This paper describes a previously unreported finding of abdominal pain as the only lifelong manifestation of hereditary angioedema in multiple family members. This diagnosis was obscured by the absence of cutaneous, oropharyngeal, and respiratory involvement. Barium studies performed during painful attacks showed transient intestinal wall edema which, along with abnormalities in the C4 level and C1 esterase inhibitor activity, confirmed the diagnosis. It is important that hereditary angioedema be recognized in its various forms so that invasive procedures can be avoided and prophylactic therapy can be administered.     

功能性腹痛综合征

功能性腹痛综合征 (ＦｕｎｃｔｉｏｎａｌＡｂｄｏｍｉｎａｌＰａｉｎＳｙｎ ｄｒｏｍｅ ,ＦＡＰＳ)又称慢性特发性腹痛或慢性功能性腹痛 ,是指持续或频繁发作的下腹痛 ,病程超过半年 ,但无胃肠道功能紊乱症状的一组临床症候群[1] 。ＦＡＰＳ患者常有抑郁、焦虑等心理障碍 ,并常伴随躯体其它部位的不适和日常活动受限。一、流行病学国外研究显示ＦＡＰＳ发病率低于其他常见的功能性胃肠疾病[2 ] 。美国人群发病率为 1 7% (多见于女性 )。我国尚无ＦＡＰＳ发病率的报道。ＦＡＰＳ患者除常就诊于消化内科外 ,还就诊于普外科和疼痛门诊等。由于…     

Functional abdominal pain syndrome

Functional abdominal pain syndrome (FAPS) differs from the other functional bowel disorders; it is less common, symptoms largely are unrelated to food intake and defecation, and it has higher comorbidity with psychiatric disorders. The etiology and pathophysiology are incompletely understood. Because FAPS likely represents a heterogeneous group of disorders, peripheral neuropathic pain mechanisms, alterations in endogenous pain modulation systems, or both may be involved in any one patient. The diagnosis of FAPS is made on the basis of positive symptom criteria and a longstanding history of symptoms; in the absence of alarm symptoms, an extensive diagnostic evaluation is not required. Management is based on a therapeutic physician-patient relationship and empirical treatment algorithms using various classes of centrally acting drugs, including antidepressants and anticonvulsants. The choice, dose, and combination of drugs are influenced by psychiatric comorbidities. Psychological treatment options include psychotherapy, relaxation techniques, and hypnosis. Refractory FAPS patients may benefit from a multidisciplinary pain clinic approach.     

An abdominal pain syndrome in a lupus patient

Systemic lupus erythematosus can be complicated by the antiphospholipid syndrome (APS). The clinical manifestations of this syndrome most often documented thus far are recurrent deep venous thrombosis, recurrent spontaneous abortions, and cerebral vascular accidents. Abdominal ischemic events have received relatively little attention in prior reports. We report on a lupus patient with lupus anticoagulant positivity who presented with abdominal pain, anorexia, and weight loss who was subsequently diagnosed with gastric ulcers and pancreatitis. Computerized tomography of the abdomen in addition revealed splenic and kidney infarcts. We conclude that this patient had (ischemic) chronic pancreatitis with pseudocysts and splenic and renal infarcts probably due to secondary APS.