P0189 - Recurrent Pancreatitis in Pediatric-Onset Median Arcuate Ligament Syndrome: A Case Report

Amanda Rigdon, MD¹, Omar Zuhdi, MD¹, Camila Villacreses, DO¹, Brian Byun, DO², Sai Wan, MD²
1Lakeland Regional Health Medical Center, Lakeland, FL; 2Lakeland Regional Health, Lakeland, FL

Introduction: Median arcuate ligament syndrome (MALS) is a rare vascular compression disorder that predominantly affects young adults. The association between MALS and recurrent pancreatitis represents an uncommon but clinically significant complication. We present a case of pediatric-onset MALS with chronic recurrent pancreatitis spanning 15 years.

Case Description/

Methods: A 20-year-old female with MALS diagnosed at age 5 presented with 3-4 days of intermittent diffuse abdominal pain and nausea. She reported annual episodes of pancreatitis since childhood. Physical examination revealed classic epigastric tenderness. Laboratory studies showed elevated lipase (279 U/L), leukocytosis (12.1 × 10³/μL), and normal lipid panel. CT abdomen/pelvis demonstrated no acute findings. Her extensive surgical history included two failed celiac artery stent placements with subsequent removal due to complications, and unsuccessful arcuate ligament decompression surgery. Multiple comprehensive pancreatitis workups remained negative for alternative etiologies. The patient was managed conservatively with IV fluid resuscitation, diet advancement, and symptomatic treatment. She achieved clinical improvement and was discharged with gastroenterology follow-up.

Discussion: This case illustrates the challenging management of MALS-associated recurrent pancreatitis. The patient's 15-year history of annual pancreatitis episodes beginning in early childhood represents an unusual presentation of MALS complications. Despite multiple interventional attempts including endovascular and surgical approaches, her symptoms persisted, highlighting the refractory nature of some MALS cases. The negative comprehensive pancreatitis evaluations support MALS as the primary etiology. Conservative management remains the mainstay when surgical interventions fail. This case emphasizes the need for multidisciplinary care and continued research into alternative therapeutic approaches for complex MALS presentations with associated pancreatic complications.


Figure: CT Abdomen Pelvis Sagittal View of Celiac Artery Compression Via Median Arcuate Ligament


Figure: CT Abdomen Pelvis Axial View of Celiac Artery Compression Via Median Arcuate Ligament

Disclosures:
Amanda Rigdon indicated no relevant financial relationships.
Omar Zuhdi indicated no relevant financial relationships.
Camila Villacreses indicated no relevant financial relationships.
Brian Byun indicated no relevant financial relationships.
Sai Wan indicated no relevant financial relationships.

Amanda Rigdon, MD¹, Omar Zuhdi, MD¹, Camila Villacreses, DO¹, Brian Byun, DO², Sai Wan, MD². P0189 - Recurrent Pancreatitis in Pediatric-Onset Median Arcuate Ligament Syndrome: A Case Report, ACG 2025 Annual Scientific Meeting Abstracts. Phoenix, AZ: American College of Gastroenterology.