Median Arcuate Ligament Syndrome

Median arcuate ligament syndrome (MALS) is uncommon and often difficult to diagnose due to the vague presenting symptoms of abdominal pain, weight loss, and early satiety. Here, we report the case of a 63 year-old man who was successfully treated with laparoscopic median arcuate ligament release. Computed tomography (CT) of the abdomen and pelvis performed preoperatively demonstrated compression of the celiac artery with post-stenotic dilatation consistent with MALS. Subsequently, laparoscopic median arcuate ligament release was performed without any complications. Postoperatively, the patient reported resolution of abdominal pain with increased appetite and weight gain. Nonspecific abdominal pain and weight loss may raise concern for malignancy, but MALS should also be considered in the differential diagnoses. Diagnosis can be confirmed with CT and/or angiography. Median arcuate ligament release results in partial if not complete resolution of symptoms due to decompression of the celiac artery as well as division of the overlying celiac plexus.