Meeting abstract

https://doi.org/10.24869/spsih.2026.252

Collaboration Between Gastroenterologists and Psychiatrists in the Treatment of Complex Patients: A Case Report of a Patient With Median Arcuate Ligament Syndrome

Branimir Margetić ; Department of Psychiatry, Dubrava University Hospital, Zagreb, Croatia *
Agata Ladić ; Department of Gastroenterology, Hepatology and Clinical Nutrition, Dubrava University Hospital, Zagreb, Croatia
Ivica Grgurević ; Department of Gastroenterology, Hepatology and Clinical Nutrition, Dubrava University Hospital, Zagreb, Croatia
Tea Plišić ; Department of Psychiatry, Dubrava University Hospital, Zagreb, Croatia

* Corresponding author.

Abstract

Median arcuate ligament syndrome (MALS) is
a rare condition associated with compression of
the celiac artery. It is characterized by abdominal
pain, nausea, and weight loss, often accompanied
by insomnia, low mood, and long-standing anxiety.
Surgical treatment is the method of choice,
but symptoms may recur. In such situations, it
is often unclear what the appropriate therapeutic
option is. This report presents a case in which
treatment with psychotropic medications led to
improvement in psychological symptoms as well
as a reduction in the intensity of gastrointestinal
complaints. Mr. A was 43 years old when he
was rehospitalized for recurrent MALS symptoms seven months after surgery. Abdominal
ultrasound with a respiratory maneuver showed
changes in peak systolic velocity in the celiac artery
that were typical for MALS and essentially
matched those recorded preoperatively, regardless
of the previous operation. In addition to severe
pain, the patient had symptoms of anxiety,
depression, and insomnia. Treatment with pregabalin,
sulpiride, and mirtazapine was initiated.
This regimen led to substantial improvement
within a few days. Seven months after starting
pharmacotherapy, the patient reported only occasional
mild pain, had no prior psychological difficulties,
and abdominal ultrasound showed normalization
of peak systolic velocity in the celiac
artery. At that point, it was judged that treatment
could be discontinued. Worsening occurred after
about ten days, and the intensity of symptoms
became increasingly marked over the course of
a month. The previous treatment was therefore
reintroduced, again resulting in a reduction of
physical symptoms and improvement in psychological
status. This case report describes experience
with treating recurrent MALS symptoms
using psychotropic medications and underscores
the need for collaboration between gastroenterologists
and consultation-liaison psychiatrists in
the management of complex patients.

Keywords

consultation-liaison psychiatry; psychopharmacology; median arcuate ligament syndrome

Hrčak ID:

352911

URI

https://hrcak.srce.hr/352911

Publication date:

15.6.2026.

Article data in other languages: croatian

Visits: 0 *