DUNBAR ‘S (MALS) SYNDROME (Harjola—Marable Syndrome).

Condition is also called as median arcuate ligament syndrome(MALS) or coeliac artery syndrome or coeliac band syndrome.There is a connecting band between right and left crura which causes compression of celiac artery and SMA.

It may cause foregut ischaemia due to inadequate collaterals, or midgut ischaemia due to diversion of blood to foregut.

SYMPTOMS - 

chronic abdominal pain after food, murmur in epigastric region, weight loss.

• Pain in the upper middle stomach area, which may go away when leaning forward
• Stomach pain after eating, exercising or changing body position
• Bloating
• Diarrhea
• Fear of eating food due to pain, leading to significant weight loss — usually greater than 20 pounds (9.1 kilograms)
• Nausea and vomiting.

DIAGNOSIS: It is often difficult to diagnosis.

• CT scan
• CT angiogram may show poor perfusion.
• MRI may be useful.
• GDA clamp test and intra operative Doppler is very useful.
• Blood tests.
• Ultrasound of the abdomen..
• Upper endoscopy

TREATMENT—

• cutting/excising the fibrous band, with removal of the celiac ganglion through laparotomy or laparoscopy.
• Coeliac angioplasty, aortocoeliac bypass, coeliac endostenting and coeliac reimplantation are also tried