The median arcuate ligament is the fibrous arch formed by the fusion of the right and left diaphragmatic crura over the aortic hiatus at approximately the T12-L1 level, through which the aorta, thoracic duct, and azygos vein pass.
Forms the roof of the aortic hiatus, allows passage of the aorta from the thorax to the abdomen at T12, provides the midline diaphragmatic attachment, and may compress the celiac artery in median arcuate ligament syndrome (MALS).
Median arcuate ligament syndrome (celiac artery compression syndrome) occurs when the median arcuate ligament compresses the celiac axis from above, producing postprandial angina from mesenteric ischaemia. CT with expiration shows the characteristic hook-shaped celiac compression. Surgical or laparoscopic MAL release decompresses the celiac axis.
Celiac artery compression by the low-lying median arcuate ligament producing postprandial epigastric pain and weight loss, treated by laparoscopic MAL division with or without celiac ganglionectomy.
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