Background

Median Arcuate Ligament Syndrome (MALS) is a condition in which the median arcuate ligament compresses the celiac artery and celiac plexus causing celiac stenosis, post-prandial pain, and unintentional weight loss. Median arcuate ligament compression is found in about 10-25% of the population but the syndrome is rare. The incidence of MALS is about 2 in every 100,000 patients. We present a case of a 48-year-old female with a history of adjustable gastric banding. This patient presented with chronic epigastric pain. A CTA of the abdomen and pelvis as well as vascular ultrasound were performed. The CTA demonstrated moderate ostial stenosis with an hooked appearance of the celiac trunk and the ultrasound demonstrated significant stenosis of the celiac artery during exhalation which improved with inhalation consistent with MALS. In review of existing medical literature two articles mentioned a total of 3 patients who underwent Roux-en-Y gastric bypass and later developed MALS. To the best of our knowledge, this is the first case of MALS in a patient with an adjustable gastric band. Although the bariatric procedure is different, the etiology of our patient's MALS may be the same as the gastric bypass patients. The patient underwent removal of her gastric band and a median arcuate ligament release. She was discharged on post-operative day 1. One month after surgery she was recovering well and symptom free.