Median arcuate ligament syndrome

Abstract

Chronic abdominal pain has several aetiologies, and many a times, the aetiology is one of the exclusions. Median arcuate ligament syndrome (MALS) also called coeliac artery compression syndrome is a form of chronic mesenteric ischaemia, although rare is an important cause. A 20-year-old male presented with recurrent episodes of pain abdomen, with a history of multiple admissions for the same, before the surgery. His physical examination and laboratories were normal, but the computed tomography (CT) done initially gave a doubtful diagnosis of MALS. A CT angiogram was done, which showed a definite kinking of the coeliac axis. After all the other causes of abdominal pain were ruled out, the patient was taken up for surgery with a provisional diagnosis of MALS. Intraoperatively, there was fibrosis around the coeliac axis with kinking. The fibrosis was cleared, and pulsations of the artery were confirmed. Postoperatively, the patient had an uneventful recovery.