Diagnostic Role of Celiac Plexus Block in Assessing Eligibility for Corrective Surgery in a Case of Median Arcuate Ligament Syndrome.

BACKGROUND

Median arcuate ligament syndrome (MALS) is an uncommon cause of postprandial abdominal pain that can be difficult to diagnose, especially in children.

CASE REPORT: We report a 14-year-old male patient with 2 months of severe, stabbing periumbilical pain resistant to medical therapy. Mesenteric duplex ultrasound showed aliasing with a peak systolic velocity of 234 cm/s at the celiac origin, and computed tomography angiography demonstrated mild kinking with poststenotic dilatation, consistent with celiac trunk compression. Diagnostic fluoroscopy-guided bilateral posterior retrocrural celiac plexus block (CPB) produced rapid pain reduction, enabling a full meal within 6 hours. Analgesia persisted for about 48 hours. The patient subsequently underwent open MAL decompression and remained symptom free at 18-month follow-up.

CONCLUSIONS

Our case illustrates that temporary CPB may be a useful diagnostic adjunct to identify a sympathetically mediated pain component and help guide surgical candidacy in MALS.