# Median Arcuate Ligament Syndrome as a Rare Cause of Ischemic Duodenal Ulcers: A Case Report

## TL;DR

A rare case shows that median arcuate ligament syndrome can cause unusual duodenal ulcers, suggesting it should be considered in difficult-to-treat cases.

## Contribution

Highlights a rare association between median arcuate ligament syndrome and ischemic duodenal ulcers.

## Key findings

- A patient with median arcuate ligament syndrome developed ischemic and hemorrhagic duodenal ulcers.
- Symptoms resolved after medical treatment following surgical release of the ligament.
- This case suggests the syndrome may contribute to therapy-resistant duodenal ulcers.

## Abstract

The median arcuate ligament syndrome is a rare cause of postprandial abdominal pain. Diagnosis is often delayed because of the heterogeneous presentation. This case report describes a patient with worsening epigastric pain and a new onset of gastrointestinal bleeding after a robot-assisted median arcuate ligament release. Diagnostic angiography showed a patent celiac artery without residual stenosis, whereas multiple ischemic and hemorrhagic duodenal ulcers were observed upon gastroscopy. After additional medical treatment with high-dose proton pump inhibitors, the patient became asymptomatic with complete healing of the ulcer. This finding is unusual, as duodenal ulcers are not typically suggestive of median arcuate ligament syndrome. Therefore, median arcuate ligament syndrome should be considered as a contributing factor in patients with therapy-resistant duodenal ulcers.