Pediatric Median Arcuate Ligament Syndrome: A Case Report

Abstract

Median arcuate ligament syndrome (MALS) is a disorder in which the median arcuate ligament compresses the origin of the celiac artery and/or the celiac ganglion and plexus, leading to chronic gastrointestinal symptoms such as abdominal pain. We report the case of a 14-year and 3-month-old girl who presented with postprandial abdominal pain and weight loss due to reduced food intake. Abdominal ultrasonography performed 5 months after onset revealed elevated blood flow at the origin of the celiac artery, with a peak systolic velocity (PSV) of 238.8 cm/s during expiration, which markedly decreased to 154.6 cm/s during inspiration. Computed tomography demonstrated stenosis at the celiac artery origin. The patient was diagnosed as having MALS and underwent laparoscopic median arcuate ligament release at 14 years and 5 months of age. The ligament and the celiac plexus overlying the celiac artery and aorta were divided. Postoperatively, her abdominal pain resolved, and the blood flow velocity of the celiac artery decreased. Although many cases of MALS are considered subclinical, no pediatric cases have been reported in Japan. It is important to consider MALS when evaluating children with abdominal pain.