Median arcuate ligament syndrome with early collateralization in a liver transplant

The relevance of this fibrous band has been under debate since 1965 when Dunbar et al. first de- scribed a syndrome of postprandial abdominal pain and malabsorption secondary to celiac axis compres- sion by the median arcuate ligament.1 The relevance of this ligament in liver transplantation is widely ac- cepted because the ligament can cause a decrease in celiac artery blood flow leading to hepatic artery thrombosis in liver transplant recipients.2 This is often a lethal condition and the tendency may be to retransplant these patients immediately subjecting the patient to another life-threatening surgery with an unpredictable outcome. [...]recently, collateraliza- tion in the presence of hepatic artery thrombosis has been recognized as a distinctively later phenomenon taking 3 months to develop mature collaterals.3 In the setting of median arcuate ligament syndrome, this delayed development of collaterals may be too late to save the graft and save the patient.