Median arcuate ligament syndrome: Successful laparoscopic management enhanced by indocyanine green fluorescence

Median arcuate ligament syndrome (MALS) is a rare vascular disorder characterized by compression of the celiac artery by the median arcuate ligament, resulting in variable clinical presentations, including abdominal pain.

A 16-year-old female patient presented with chronic abdominal pain, recurrent vomiting, and weight loss over seven months. Doppler ultrasound showed increased peak systolic velocity in the celiac artery (331 cm/s) exacerbated during expiration and computed tomography angiography confirmed celiac artery compression with the typical "J-hook" deformity. She underwent successful laparoscopic surgical decompression assisted with indocyanine green fluorescence to confirm adequate perfusion of the celiac territory. Pre and postoperative quality of life was assessed using PedsQL scores, showing significant improvement. After a six-month follow-up, the patient remains asymptomatic.

This case highlights the importance of considering MALS in the differential diagnosis of chronic abdominal pain in adolescents and reinforces the established efficacy and safety of laparoscopic management for MALS.