SIR 2024
Pain Management/MSK
Joanna K. Weeks, MD
Resident Physician
Hospital of the University of Pennsylvania
Financial relationships: Full list of relationships is listed on the CME information page.
Lauren Shreve, MD, MBA
Integrated Interventional Radiology Resident
Hospital of the University of Pennsylvania
Disclosure information not submitted.
Michael C. Soulen, MD
Professor
Perelman School of Medicine at the University of Pennsylvania, Hospital of the University of Pennsylvania
Disclosure information not submitted.
1. Describe the typical presentation, differential diagnosis, and workup of Median Arcuate Ligament Syndrome (MALS).
2. Summarize the existing literature on Celiac Plexus Block and Neurolysis (CPB/N) as a predictive biomarker for MALS surgery.
3. Review the pre-procedural workup, procedural techniques, post-procedural assessment, and care surrounding CPB/N, including post-procedural meal challenges and pain scoring.
4. Present our institutional experience of CPB/N and post-procedural meal challenges in relation to surgical outcomes.
Background:
Median arcuate ligament syndrome is often considered a diagnosis of exclusion. It manifests as chronic post-prandial abdominal pain, food fear, nausea, vomiting, and weight loss. Presumed secondary to compression of the celiac plexus, treatment consists of surgical median arcuate ligament release and neurolysis of the plexus. Celiac plexus block and neurolysis have been increasingly utilized prior to MALS surgery for pre-surgical evaluation and diagnosis as well as treatment.
Clinical Findings/Procedure Details:
This exhibit will review the typical presentation, differential diagnosis, and workup of Median Arcuate Ligament Syndrome (MALS). We will summarize the existing literature on celiac plexus blocks and neurolysis for diagnosis and treatment of MALS. The pre-procedural workup, including patient assessment, cross sectional imaging, indications, contraindications, and procedural planning will be reviewed. An in-depth discussion of procedural techniques, including approach, landmarks, and treatment agents will be presented, followed by a review of post-procedural care, pain scoring and meal challenges, and complications. Finally, we will present institutional experience of CPB/N and post-procedural meal challenges as it relates to surgical outcomes.
Conclusion and/or Teaching Points:
Celiac plexus blocks/neurolysis has been shown effective in assisting with the diagnosis and treatment of MALS. Interventional Radiology now plays an increasing role in the assessment and treatment of MALS’ patients. This exhibit will review the existing literature of CPB/N for the diagnosis and treatment of MALS as well as procedural techniques and pre-surgical evaluation.