A case report on median arcuate ligament syndrome: Need for a high index of suspicion

Abstract

The Median Arcuate Ligament Syndrome (MALS) is a rare clinical entity occurring due to abnormally low insertion of the ligament across the origin of the coeliac axis resulting in varying degrees of celiac artery compression. Its symptoms mimic those of chronic mesenteric ischemia and its diagnosis requires a high index of clinical suspicion coupled with appropriate imaging. We report the case of a young male with pain abdomen, nausea, and vomiting in whom routine evaluation for pain abdomen was inconclusive. He was diagnosed with MALS after multi-modality imaging. The patient was suspected to have MALS by using ultrasound and color Doppler imaging. These findings were confirmed using Computed tomography angiography (CTA) of the abdomen. MALS should be considered as an important differential in patients with symptoms resembling post-prandial angina. A combination of a high index of suspicion with the use of appropriate imaging techniques can clinch this diagnosis. We describe the diagnostic challenges faced in this case with a brief review of the literature.