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Diagnostik und Therapie des Dunbar-Syndroms

Diagnosis and treatment of Dunbar syndrome

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Zusammenfassung

Das seltene Dunbar-Syndrom oder mediales Ligamentum-arcuatum-Syndrom (MALS) ist definiert als eine Kompression des Truncus coeliacus und/oder des Ganglion coeliacum durch das Ligamentum arcuatum mediale. Es wird oft erst nach einem langen Leidensweg der Patienten diagnostiziert und ist durch intermittierende nahrungsabhängige Schmerzen, Übelkeit und unklaren Gewichtsverlust gekennzeichnet. Nach Ausschluss anderer kausaler Ursachen für obige Symptomatik mittels Ösophagogastroduodenoskopie, Koloskopie, CT- oder MRT-Untersuchung ist der Goldstandard zur Diagnosestellung die dynamische, farbkodierte Duplexsonographie, welche durch eine CT- oder MR-Angiographie ergänzt werden kann. Die Therapie der Wahl stellt die meist laparoskopische Spaltung des Ligamentum arcuatum am Truncus coeliacus sowie eine lokale, nervale und lymphatische Dekompression der Gefäße dar, wobei bei postoperativer Beschwerdepersistenz oder Rezidivstenose auch eine perkutane transluminale Angioplastie (PTA) mit Stentimplantation erfolgen kann. Da in bis zu 50 % der Fälle die Symptome auch postoperativ persistieren, ist eine strenge Indikationsstellung und vollständige Diagnostik in ausgewiesenen Zentren für die chirurgische Therapie von großer Bedeutung.

Abstract

The rare Dunbar syndrome or medial arcuate ligament syndrome (MALS) is defined as compression of the celiac trunk and/or ganglion by the medial arcuate ligament. It is often diagnosed after patients have suffered for a long time and is characterized by intermittent food-related pain, nausea, and unexplained weight loss. After exclusion of other causes of the above symptoms by gastroscopy, colonoscopy, CT, or MRI, the gold standard for diagnosis is dynamic color-coded duplex sonography, which may be supplemented by CT or MR angiography. The treatment of choice is a laparoscopic division of the arcuate ligament at the celiac trunk, although percutaneous transluminal angioplasty (PTA) with stent implantation may be performed in cases of postoperative persistence of symptoms or recurrent stenosis. Since symptoms persist postoperatively in up to 50% of cases, strict indication and complete diagnosis in designated centers are of great importance for successful treatment.

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Authors and Affiliations

  1. Klinik- und Poliklinik für Allgemein‑, Viszeral‑, Thorax- und Gefäßchirurgie, Universitätsklinikum Bonn, Venusberg-Campus 1, 53127, Bonn, Deutschland

    Anna Woestemeier,  Alexander Semaan,  Jörg C. Kalff &  Philipp Lingohr MD, FACS, FEBS, FEBS (hon.)

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  1. Anna Woestemeier
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  2. Alexander Semaan
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  3. Jörg C. Kalff
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  4. Philipp Lingohr MD, FACS, FEBS, FEBS (hon.)
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Correspondence to Philipp Lingohr MD, FACS, FEBS, FEBS (hon.).

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A. Woestemeier, A. Semaan, J.C. Kalff und P. Lingohr geben an, dass kein Interessenkonflikt besteht.

Für diesen Beitrag wurden von den Autor/-innen keine Studien an Menschen oder Tieren durchgeführt. Für die aufgeführten Studien gelten die jeweils dort angegebenen ethischen Richtlinien.

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Chirurgische Dekompression des Truncus coeliacus

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Woestemeier, A., Semaan, A., Kalff, J.C. et al. Diagnostik und Therapie des Dunbar-Syndroms. Schmerz 38, 6–11 (2024). https://doi.org/10.1007/s00482-023-00766-x

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