Another Sherlock Holmes Mystery: Abdominal Pain Explained by Median Arcuate Ligament Syndrome

Abstract

Median arcuate ligament syndrome (MALS), also known as celiac artery compression syndrome, is a rare gastrointestinal condition with an estimated incidence of 2 per 100 000 population. Predominantly in female patients, this syndrome is characterized by the compression of the celiac artery at its origin from the aorta by the median arcuate ligament, which at the same time is entrapping the celiac plexus, causing upper abdominal pain, notably postprandial pain, as well as nausea, vomiting, food aversion, and weight loss. We present a case of abdominal pain secondary to MALS that was appropriately diagnosed after requiring narcotic medication, which responded to surgical therapy.

Keywords: gastroenterology; median arcuate ligament syndrome.

Figure 1.

Anatomical association of the median arcuate ligament (MAL) to the diaphragm and aorta. Blue arrow highlights the location of the MAL. Reproduced from McCallum and Al-Bayati with permission from Practical Gastro.^,

Figure 2.

Preoperative duplex ultrasound with inspiration (Left) and expiration (Right).

Figure 3.

A mesenteric arteriogram confirming stenosis of the celiac artery (Red Arrow).

Figure 4.

Postoperative duplex ultrasound Doppler with inspiration (Left) and expiration (Right).