SHM Converge Scientific Abstract ePoster Gallery-I'm Too Afraid to Eat: A Rare Case of Median Arcuate Ligament Syndrome

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This case report describes a 61-year-old woman with a 6-month history of substernal and mid-epigastric pain that worsened after eating, leading to poor oral intake over the 2–3 weeks before admission. Her medical history included coronary artery disease, antiphospholipid syndrome, Sjogren’s syndrome, and recent celiac artery stenting for focal dissection. On exam, she was hemodynamically stable but had diffuse abdominal tenderness and costovertebral angle tenderness. Laboratory studies were unrevealing.<br /><br />Given persistent symptoms, further evaluation was pursued. Autoimmune testing for vasculitis and gastrointestinal workup, including endoscopy and colonoscopy, were negative. CT angiography of the chest and CT abdomen/pelvis with contrast showed moderate to severe stenosis of the celiac trunk, consistent with compression by the median arcuate ligament, confirming median arcuate ligament syndrome (MALS), a rare diagnosis of exclusion.<br /><br />The patient initially underwent a bilateral celiac plexus block, which improved symptoms but did not fully resolve them. She then underwent surgical ligation/decompression of the median arcuate ligament, after which she had significant and sustained symptom relief without recurrence.<br /><br />The report highlights that MALS is an uncommon condition, occurring in about 2 per 100,000 patients, caused by compression of the celiac artery and celiac plexus. Typical symptoms include postprandial epigastric pain, nausea, vomiting, poor appetite, and weight loss. CT angiography is considered the diagnostic gold standard. Treatment is usually surgical decompression; celiac plexus block may provide temporary relief, and revascularization may be needed if symptoms persist.

Asset Subtitle

Justeena Joseph

Meta Tag

Author List Elise Belilos, Jiya Mulayamkuzhiyil, Jonathan London, Justeena Joseph, Mario Mekhail, Nuzhat Batool

Category Clinical Vignettes

Concept Median Arcuate Ligament Syndrome

Concept Postprandial Epigastric Pain

Concept Diagnosis of Exclusion

Concept CT Angiography

Concept Celiac Artery Compression

Distinguished Non-Finalist

Presenter Organization Long Island Community Hospital

Presenting Author Justeena Joseph

Track Adult

Keywords

median arcuate ligament syndrome

MALS

postprandial epigastric pain

celiac artery compression

celiac trunk stenosis

CT angiography

celiac plexus block

surgical decompression

abdominal pain

rare diagnosis

Median Arcuate Ligament Syndrome

Postprandial Epigastric Pain

Diagnosis of Exclusion

CT Angiography

Celiac Artery Compression