Median Arcuate Ligament Syndrome: An Unusual Cause of Chronic Abdominal Pain

Chronic abdominal pain is one of the most frequent complaints of subjects visiting the gastroenterologist office and a large majority of these subjects have irritable bowel syndrome (IBS). Median arcuate ligament syndrome (MALS) is a rare cause of chronic abdominal pain that results from compression or ischemia of the celiac artery by the median arcuate ligament. Characteristic features include weight loss and postprandial pain, and the diagnosis can be confirmed by radiographic imaging. Surgical treatment can be curative. MALS is a diagnosis of exclusion and requires a high level of suspicion. Herein we present three unique cases of patients with chronic abdominal pain discovered to have MALS and we review the literature.