Median Arcuate Ligament Syndrome With Concomitant Hyperkinetic Gallbladder

Abstract

Median arcuate ligament syndrome (MALS) is a rare condition characterized by compression of the celiac artery and ganglia by the median arcuate ligament, leading to gastrointestinal symptoms such as chronic epigastric and postprandial pain. Hyperkinetic gallbladder dyskinesia (HGBD), defined as a gallbladder ejection fraction (GBEF) > 80%, often presents with symptoms that overlap with MALS. We conducted a retrospective chart review of patients who had a history of HGBD identified by GBEF and were surgically treated for MALS at our institution. Of the 69 patients undergoing MALS surgery, 6 had GBEF >80%. The cohort (mean age 31 ± 16.8; BMI 24.0 ± 5.6) was predominantly female (83.3%). Abdominal pain, exacerbated postprandially, was the primary symptom reported. All patients had multiple vascular compression syndromes and reported symptomatic improvement post-surgery. Given their overlapping presentations, patients with HGBD should undergo evaluation for MALS, as surgical release provides effective symptom relief.