Median arcuate ligament syndrome and aneurysm in the pancreaticoduodenal artery detected by retroperitoneal hemorrhage: A case report

Median arcuate ligament syndrome (MALS), also known as celiac artery/axis compression syndrome, is a rare cause of abdominal pain.1 MALS occurs due to extraluminal compression of the celiac artery (CA) by the median arcuate ligament (MAL), which is a part of the diaphragm. In this report, we describe the case of a 47‐year‐old male presenting with sudden epigastric pain diagnosed as aneurysm rupture in the inferior pancreaticoduodenal artery (PDA) and retroperitoneal hemorrhage. The patient was discharged with no major complications following emergent interventional radiology (IVR) for PDA coil embolization. Decompression surgery was performed to prevent further aneurysm formation as the PDA aneurysm was thought to result from CA stenosis via extraluminal compression by MAL and increase blood flow from the SMA, which was developed to compensate for the CA perfusion area.