Median Arcuate Ligament Syndrome, a rare presentation

The median arcuate ligament that unites the diaphragmatic crura on either side of the aortic hiatus can lie low in some individuals and cause symptomatic compression which can present clinically in different forms. A 63 year old lady presented to the emergency with an acute abdomen, generalized guarding and rigidity with severe tenderness over the umbilical region. Owing to the deteriorating status, patient underwent emergency laparotomy and was found to have bled owing to rupture of a pseudoaneurysm arising from the SMA collaterals in the pancreatico-duodenal arcade. CTA showed a hook shaped focal narrowing of the coeliac artery near its origin. The lady subsequently underwent DSA under local anaesthesia and 33 glue - lipiodol embolisation of the pseudoaneurysm with complete obliteration of the aneurysm from the circulation was achieved. CTA can play a role in the diagnosis of this condition with the appropriate clinical symptoms. Collaterals may form pseudoaneurysm and bleed. When they present acutely with bleeding, they can be successfully treated endovascularly with glue coils