Celiacomesenteric Trunk as a Cause of Median Arcuate Ligament Syndrome

A 28-year-old man presented with a constellation of symptoms with 6 months of duration, most prominent being unexplained weight loss of 35 pounds and postprandial abdominal discomfort. Multiple specialist consultations, laboratory and instrumental studies did not yield a unifying diagnosis. The patient had been treated with multiple medications without improvements. On examination, an epigastric bruit that increased with expiration and decreased with inspiration raised suspicion for median arcuate ligament syndrome (MALS). Ultrasonography of the mesenteric arteries revealed a rare anatomical variant of abdominal vessels known as celiacomesenteric trunk (the celiac artery and superior mesenteric artery sharing a common origin from the aorta). There was also a median arcuate ligament impression on the celiac artery and marked respiratory variations of Doppler velocities in support of the diagnosis of MALS. This is a case report of celiacomesenteric trunk clinically associated with MALS.