Median Arcuate Ligament Syndrome in a Six-year-old Girl Presenting with Recurrent Abdominal Pain: A Case Report

Abstract

Background: Median arcuate ligament syndrome (MALS) is an uncommon consideration in children with chronic postprandial abdominal pain. Because coeliac artery compression can be an asymptomatic anatomical finding, clinical correlation is essential. Case Presentation: A six-year-old girl experienced approximately two years of intermittent abdominal pain and nonbilious vomiting, frequently exacerbated by meals and recumbency. Previous investigations and empirical antitubercular treatment had not established an explanation for the persistent symptoms. Contrast-enhanced abdominal computed tomography demonstrated mild focal narrowing at the origin of the coeliac artery with mild post-stenotic dilatation. Available Doppler screenshots showed peak systolic velocities of 81.43 cm/s while supine and 33.50 cm/s while sitting; standardised respiratory-phase measurements were not documented. Open division of the median arcuate ligament was followed by improved tolerance of oral feeding, a postoperative Doppler study described as normal, and a reported absence of recurrent symptoms during follow-up of unspecified duration. Conclusion: This case illustrates the diagnostic complexity of suspected MALS in a young child with recurrent postprandial symptoms. The anatomical and clinical observations are compatible with a symptomatic vascular compression disorder but do not establish symptom causation from imaging findings alone.