Volume 50, Issue 2 Summer 2026 JVU 502-81 | Celiac Artery Compression by the Median Arcuate Ligament with Potential Contribution from an Overlying Arterial Branch: A Case Report-Celiac Artery Compression

Celiac Artery Compression

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This case report describes a 46-year-old woman with years of postprandial right upper quadrant abdominal pain, exercise-related discomfort, and unintentional weight loss. She had previously undergone an extensive gastrointestinal workup and laparoscopic cholecystectomy for gallbladder dyskinesia, but her symptoms persisted and worsened, prompting vascular evaluation.<br /><br />Duplex ultrasound and computed tomography angiography showed classic findings of celiac artery compression consistent with median arcuate ligament syndrome (MALS): markedly elevated celiac artery velocities at rest that decreased with deep inspiration but did not fully normalize. However, imaging also revealed an unusual small arterial branch crossing over the celiac artery at the site of narrowing, likely an accessory hepatic artery. This raised uncertainty about whether the median arcuate ligament alone caused the compression or whether the overlying branch also contributed.<br /><br />Because of ongoing symptoms and imaging-confirmed compression, the patient was placed on the MALS surgical pathway after counseling and preoperative pain management and psychology evaluation. During surgery, the median arcuate ligament and surrounding fibrous and nerve tissue were dissected and released. The overlying arterial branch seen on imaging was identified intraoperatively and ligated. Extensive neurolysis was also performed to address the neurologic component of the syndrome. Intraoperative duplex ultrasound showed normalization of celiac artery flow velocities, confirming successful decompression.<br /><br />The authors emphasize that celiac artery compression can be diagnostically complex, especially when atypical anatomy such as an overlying arterial branch is present. Careful review of imaging and intraoperative anatomy is important to avoid incomplete decompression or vascular injury. The case highlights the value of duplex ultrasound and CTA in diagnosis and surgical planning, and it supports a multidisciplinary approach to managing MALS.

Keywords

median arcuate ligament syndrome

celiac artery compression

duplex ultrasound

computed tomography angiography

postprandial abdominal pain

accessory hepatic artery

surgical decompression

neurolysis

vascular anatomy

weight loss