Background: The median arcuate ligament is formed where the diaphragmatic crura joins near the 12^th thoracic vertebra. Median arcuate ligament syndrome results in abdominal pain due to compression of the celiac artery or ganglia by the median arcuate ligament.

Case Description: The patient is a 22-year-old female with chronic postprandial abdominal pain for years. She underwent an extensive preoperative work-up including a laparoscopic cholecystectomy and several ERCPs with resultant pancreatitis. A gastric emptying study and MRI secretin study were within normal limits. A CT angiogram of the abdomen demonstrated narrowing of the celiac artery origin. An arterial mesenteric ultrasound demonstrated elevated dynamic velocities of the celiac artery consistent with median arcuate ligament compression. A celiac plexus block demonstrated symptomatic improvement. She underwent a laparoscopic median arcuate ligament release with intraoperative ultrasound. The patient had an uneventful initial postoperative course, however, redeveloped symptoms 11 weeks postoperatively with repeat elevated velocities on mesenteric artery duplex. A redo median arcuate ligament syndrome release was performed and the patient demonstrated improvement of her symptoms and imaging results.

Conclusion: Laparoscopic repair of median arcuate ligament syndrome release is a safe procedure and may be repeated if initial inadequate release is noted and confirmed with mesenteric artery duplex imaging.