Median arcuate ligament syndrome without weight loss: A challenging diagnosis

SUMMARY: Median arcuate ligament syndrome (MALS) is a rare vascular compression disorder of the celiac artery, typically presenting with postprandial abdominal pain and weight loss. We report a 44-year-old woman with chronic postprandial epigastric pain and nausea, but without weight loss. Her medical history included hypothyroidism, which may have masked this classical feature. Duplex ultrasonography revealed hemodynamically significant celiac artery compression with elevated peak systolic velocities. The patient underwent successful laparoscopic decompression of the median arcuate ligament, with sustained resolution of symptoms. This case highlights the diagnostic challenges of atypical MALS presentations and emphasises duplex ultrasonography as a valuable tool.