Median Arcuate Ligament Syndrome (MALS) With a Spontaneous Dissecting Aneurysm of the Celiac Axis

TL;DR

This paper reports a rare case of a 42-year-old man with both MALS and a celiac artery aneurysm, managed conservatively and adding to limited literature on this condition.

Contribution

The paper presents a rare case of MALS coexisting with a celiac artery dissecting aneurysm and advocates for conservative management in select patients.

Findings

The patient was managed conservatively with antihypertensives and outpatient follow-up due to hemodynamic stability.

The case highlights the potential for safe conservative management in select patients with MALS and celiac artery aneurysm.

Previously documented cases show varied treatment approaches based on aneurysm stability and rupture risk.

Abstract

We present the fifth documented case, out of a total of four reported in the literature to date, of concurrent median arcuate ligament syndrome (MALS) and celiac artery dissecting aneurysm. A 42-year-old male arrived at the emergency department with acute-onset epigastric and left upper quadrant pain radiating to the left flank, accompanied by nausea without vomiting. Imaging with computed tomography angiography (CTA) confirmed a 1.3 cm dissecting aneurysm of the celiac axis with significant proximal stenosis caused by compression from the median arcuate ligament, consistent with MALS. The diagnosis was based solely on imaging findings; no specific clinical diagnostic criteria were applied. The patient was managed conservatively due to hemodynamic stability, absence of rupture, and stable aneurysmal size on serial imaging. He was discharged with antihypertensives and close outpatient follow-up, with a scheduled vascular surgery consultation in two weeks. We also discuss in this report the previously documented cases of the same or similar occurrences. Across these cases, treatment varied from conservative management to surgical intervention, often influenced by aneurysm stability and rupture risk. Our case adds to the limited literature on this rare presentation and highlights the potential for safe conservative management in select patients. It also underscores the need for diagnostic vigilance and follow-up protocols to better stratify management strategies in MALS-associated vascular complications. These cases emphasize the clinical importance of recognizing the rare coexistence of MALS and celiac artery dissection. Reporting such cases enhances awareness, facilitates early diagnosis, and may inform the development of standardized management approaches.

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