A Rare Imaging Case of Median Arcuate Ligament Syndrome

Abstract

Aims: This case report aims to demonstrate a rare case of median arcuate ligament syndrome (MALS) and the importance of multimodal imaging in a setting of resource restriction. Presentation of Case: Patient presented with a long term intermittent postprandial abdominal pain not controlled on analgesia. Interestingly the US abdomen and pelvis along with the Oesophagogastroduedonoscopy was normal. On review it was decided that the patient should still undergo CTangiography of the celiac trunk as a final investigation which revealed a thickened median arcuate ligament causing celiac trunk compression. Laparoscopic surgery was undertaken to release the ligament. Post operative follow up indicated near total resolution of symptoms.  Discussion: The case highlights the importance of using multimodal radiological findings to diagnose median arcuate ligament syndrome which in itself is a rare condition. This is particularly important in low resource settings with heavy demands as further investigations may not be instigated due to increasing wait-lists. The case is also a good reminder that MALS, though rare, should not be excluded as a differential without a CT angiography in patients with postprandial abdominal pain.