Clinical Report: Median Arcuate Ligament Syndrome Misdiagnosed as Cannabis Hyperemesis Syndrome

Overview

This case study presents a 25-year-old woman initially diagnosed with cannabis hyperemesis syndrome, later found to have median arcuate ligament syndrome (MALS) due to significant celiac artery compression. The report highlights the diagnostic challenges associated with MALS.

Background

Median arcuate ligament syndrome (MALS) is a rare condition characterized by the compression of the celiac artery by the median arcuate ligament, leading to gastrointestinal symptoms. It often presents with nonspecific symptoms that overlap with more common gastrointestinal disorders, complicating diagnosis.

Data Highlights

The patient experienced recurrent abdominal pain, nausea, and vomiting, which were initially attributed to cannabis hyperemesis syndrome. Imaging studies, including CT angiography, demonstrated over 70% stenosis of the celiac artery, confirming the diagnosis of MALS. The patient reported significant symptom relief following dietary modifications and medical management.

Key Findings

• The patient was misdiagnosed with cannabis hyperemesis syndrome after multiple emergency visits.

• Imaging revealed over 70% stenosis of the celiac artery, confirming MALS.

• MALS symptoms include postprandial pain, nausea, vomiting, and weight loss.

• Diagnosis of MALS often requires exclusion of other conditions due to symptom overlap.

• Management options for MALS include surgical intervention, which the patient declined.

Clinical Implications

Healthcare providers should consider MALS in patients presenting with recurrent gastrointestinal symptoms.

Conclusion

This case illustrates the diagnostic challenges associated with MALS.

Related Resources & Content

1. Frontiers in Medicine, 2026 -- The interplay of maturity-onset diabetes of the young, obesity, uncontrolled hypertension, and cannabinoid hyperemesis in the progression to end-stage renal disease: a case report

2. MDSpire News -- CVS Diagnosis and Management: AGA Provides Comprehensive Update

3. Management of Surgical Interventions for Celiac Artery and Superior Mesenteric Artery Compression Syndromes

4. Surgical Endoscopy -- Impact of preoperative cannabis use on outcomes following surgical intervention for gastroparesis

5. European Society for Vascular Surgery (ESVS) 2025 Clinical Practice Guidelines on the Management of Diseases of the Mesenteric and Renal Arteries and Veins

6. Cannabinoid Hyperemesis Syndrome

7. European Society for Vascular Surgery (ESVS) 2025 Clinical Practice Guidelines on the Management of Diseases of the Mesenteric and Renal Arteries and Veins☆