# Diagnosing Median Arcuate Ligament Syndrome in a Patient With a History of Duodenal Lymphoma: A Case Report

## TL;DR

A 60-year-old man with a history of duodenal lymphoma and diabetes was diagnosed with MALS after years of unexplained stomach pain and found relief through surgery.

## Contribution

This case highlights MALS as a potential cause of chronic abdominal pain in patients with complex medical histories.

## Key findings

- CT angiogram confirmed MALS with celiac artery stenosis due to diaphragmatic crus compression.
- Laparoscopic median arcuate ligament release provided significant symptom relief.
- MALS should be considered in patients with unexplained chronic postprandial epigastric pain.

## Abstract

Median arcuate ligament syndrome (MALS) is a rare vascular disorder that leads to a constellation of nonspecific gastrointestinal symptoms. We present a case of a 60-year-old male with a history of duodenal lymphoma in remission, insulin-dependent diabetes mellitus, and longstanding gastrointestinal symptoms, who developed worsening postprandial epigastric pain over eight months. Despite extensive evaluations including esophagogastroduodenoscopy (EGD), gastric emptying studies, and a hepatobiliary iminodiacetic acid (HIDA) scan, no definitive cause was identified. A computed tomography (CT) angiogram revealed anterior superior indentation of the proximal celiac artery by the diaphragmatic crus and post-stenotic dilation, consistent with MALS. The patient underwent laparoscopic median arcuate ligament release, resulting in significant symptom relief. This case underscores the importance of considering MALS in patients with chronic abdominal pain, even those with complex medical histories.