The median arcuate ligament is the fibrous arch connecting the right and left diaphragmatic crura as they cross anterior to the aorta at the aortic hiatus (T12). It forms the roof of the aortic hiatus and may compress the coeliac trunk immediately below it, particularly during expiration when the diaphragm descends.
Median arcuate ligament syndrome (MALS / coeliac artery compression syndrome) occurs when the ligament compresses the coeliac trunk, producing postprandial abdominal pain, weight loss, and an epigastric bruit. Ultrasound with deep expiration demonstrates increased coeliac trunk velocity. MR angiography confirms the extrinsic compression. Surgical or laparoscopic division of the ligament decompresses the coeliac axis. It is more common in young, thin women and may coexist with coeliac plexus dysfunction.
Extrinsic compression of the coeliac trunk by the median arcuate ligament producing postprandial epigastric pain, weight loss, and an epigastric bruit, treated by laparoscopic ligament division with or without coeliac plexus neurolysis.
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