Median Arcuate Ligament Syndrome (Dunbar Syndrome): The Importance of the Pre-Operative Study in Surgical Planning

The median arcuate ligament syndrome, also known as Dunbar syndrome, is caused by stenosis of the celiac trunk due to compression by diaphragmatic fibres. The incidence of this condition remains unclear and its clinical presentation is multifarious. Diagnosis is established by angio-computed tomography to determine the extent of stenosis and the existence or not of collateral circulation. Surgical intervention remains the favoured treatment. We present the case of a 40-year-old man diagnosed with a cephalopancreatic neuroendocrine tumour proposed for a pancreatoduodenectomy. Preoperative imaging studies revealed significant celiac-mesenteric collateral circulation, raising doubts about whether it was caused by a celiac trunk agenesis versus a median arcuate ligament syndrome. This finding would significantly influence the choice of surgical strategy, particularly the need for vascular anastomoses or not. We hereby present its intraoperative findings and the surgical solution, enhancing the importance of the preoperative imaging studies.