Abstract
Median arcuate ligament syndrome (MALS) is a rare vascular disorder that leads to a constellation of nonspecific gastrointestinal symptoms. We present a case of a 60-year-old male with a history of duodenal lymphoma in remission, insulin-dependent diabetes mellitus, and longstanding gastrointestinal symptoms, who developed worsening postprandial epigastric pain over eight months. Despite extensive evaluations including esophagogastroduodenoscopy (EGD), gastric emptying studies, and a hepatobiliary iminodiacetic acid (HIDA) scan, no definitive cause was identified. A computed tomography (CT) angiogram revealed anterior superior indentation of the proximal celiac artery by the diaphragmatic crus and post-stenotic dilation, consistent with MALS. The patient underwent laparoscopic median arcuate ligament release, resulting in significant symptom relief. This case underscores the importance of considering MALS in patients with chronic abdominal pain, even those with complex medical histories.