Median arcuate ligament syndrome often poses a diagnostic challenge: A literature review with a scope of our own experience

The median arcuate ligament syndrome (MALS) is recognized as a rare clinical entity, characterized by chronic post-prandial abdominal pain, nausea, vomiting, and unintentional weight loss. Due to its vague symptomatology, it is mainly regarded as a diagnosis of exclusion. Patients can often be misdiagnosed for several years before a correct diagnosis is established, also due to a medical team’s clinical suspicion. We present a case series of two patients who suffered from MALS and were treated successfully. The first patient is a 32-year-old woman, presenting with post-prandial abdominal pain and weight loss that have lasted for the past ten years. The second patient, a 50-year-old woman, presented with similar symptomatology, with the symptoms lasting for the last five years. Both cases were treated by laparoscopic division of the median arcuate ligament fibers, which alleviated extrinsic pressure from the celiac artery. Previous cases of MALS were retrieved from PubMed, to assemble a better diagnostic algorithm and propose a treatment method of choice. The literature review suggests an angiography with a respiratory variation protocol as the diagnostic modality of choice, along with the laparoscopic division of the median arcuate ligament fibers as the proposed treatment of choice.

Successful closure of a complicated duodenal ulcer perforation with an expandable esophageal stent

Laparotomy and reoperation remain the standard procedures for patients with suture line disruption after the initial surgical treatment for duodenal ulcer perforation has failed. Recently, endoscopic stents have been employed for dehiscence of the suture line after a surgical repair or even as a primary treatment. We present such a case, the fourth in the literature. In this case, a partially covered stent was placed to cover the duodenal perforation opening after an unsuccessful stitching 6 days earlier. We discuss the difficulties in stent positioning, the choice of sealant, and possible complications. Overall, for older patients with comorbidities, endoscopic stent placement could be considered a promising alternative minimally invasive treatment.

Differences in pharyngeal according to angle class of malocclusion

Objectives: To investigate potential differences in the pharynx, the soft palate, the pharyngeal tonsil, and the tongue between patients with different Angle Classes of malocclusion. Study Design: Pre-treatment lateral cephalograms of 116 normal breathing individuals aged between 9 and 12 years were analyzed. 20 linear and 4 angular measurements, as well as 5 variables concerning the surface area of the pharynx and the soft palate were evaluated. Results: The angle formed by the palatal plane and the base of the skull had lower values in Class II groups. The soft palate height was smaller in Class II, div. 1 group. The angle between the soft and hard palates was smaller in Class III, followed by Class I, Class II, div. 2, and Class II, div. 1, with increasing values. The distance of the tongue from the palatal plane was larger in Class I and Class III groups. The surface area of the oropharynx was larger in Class III than in Class II groups. The total surface area of the pharynx had higher values in Class III than in Class II/1. Conclusion: Subjects with Class II malocclusion may be more prone to develop respiratory related disorders, such as obstructive sleep apnea, followed by Class I and Class III subjects.