Median Arcuate Ligament Syndrome Misdiagnosed as Cannabis Hyperemesis Syndrome: A Case Study

Category	Detail
Condition	Median Arcuate Ligament Syndrome (MALS)
Key Mechanisms	Compression of the celiac artery by the median arcuate ligament, leading to diminished blood flow to foregut organs.
Target Population	Predominantly women aged 30 to 50 years, with a female-to-male ratio of 4:1.
Care Setting	Emergency department and outpatient vascular surgery follow-up.

MALS can be misdiagnosed due to symptom overlap with more common gastrointestinal disorders.
Symptoms include postprandial epigastric pain, nausea, vomiting, and unintended weight loss.
Diagnostic approaches include mesenteric duplex ultrasound, CT angiography, and MRI angiography.
Laparoscopic decompression is a common management option, though not standardized.
Greater awareness of MALS is needed to reduce diagnostic delays.

Diagnosis of MALS is often a diagnosis of exclusion due to nonspecific symptoms.

Laparoscopic decompression involving MAL release and celiac ganglionectomy is commonly preferred.

Follow-up imaging may be necessary to assess for symptom recurrence or complications.

Surgical intervention risks include complications related to laparoscopic procedures.

Patients with MALS may present with recurrent gastrointestinal symptoms.

Management options are limited for patients who decline surgery or are pregnant.

Consider MALS in patients with recurrent gastrointestinal symptoms and atypical presentations.
Utilize appropriate imaging modalities to confirm diagnosis.

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

Clinical Scorecard: Median Arcuate Ligament Syndrome Misdiagnosed as Cannabis Hyperemesis Syndrome: A Case Study