Disclosures: Terence Hillery, MD: No financial relationships or conflicts of interest

Case Diagnosis: Median Arcuate Ligament Syndrome (MALS)

Case Description: A 56 year old female presented to an academic outpatient facility to be evaluated for a 30 year history of abdominal pain, nausea and vomiting, for which the patient had seen numerous providers. A recent CT scan of the abdomen showed mild to moderate narrowing of the proximal celiac artery due to mass effect from the arcuate ligament, predominantly along the right anterolateral aspect of the celiac artery, resulting in mild leftward deviation of the celiac artery. The patient was offered several treatment options and chose celiac plexus block.

Setting: Outpatient clinic, academic medical centerAssessment/

Results: The patient experienced 100% relief of pain and associated nausea for 6 months. Her symptoms returned, the block was repeated, and she reported sustained pain relief at 12 months.

Discussion: Median arcuate ligament syndrome (MALS) is a painful condition thought to be caused by impingement of the median arcuate ligament upon the celiac artery, resulting in abdominal pain, classically postprandial and associated with weight loss and nausea. Celiac plexus block is a therapeutic technique used to treat abdominal pain, commonly elected in the setting of malignancy or chronic pancreatitis.

Conclusion: Although MALS is a rare and controversial diagnosis, the condition can be debilitating due to severe abdominal pain, nausea, vomiting and weight loss. Treatment options include surgical release and celiac plexus blocks. This case is consistent with the literature supporting celiac plexus block as an important diagnostic and therapeutic tool in MALS.

Level of Evidence: Level V

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PM&R Meeting Abstracts - https://pmrjabstracts.org/abstract/celiac-plexus-block-for-treatment-of-median-arcuate-ligament-syndrome-mals-symptoms-a-case-report/