Retroperitoneal approach for redo median arcuate ligament release

Median arcuate ligament syndrome (MALS) is a cause of chronic abdominal pain that can be difficult to diagnose and treat, as the pathophysiology is not completely understood and there is no definitive diagnostic and treatment algorithm. We present the case of a 39-year-old man with debilitating symptoms of MALS for 18 years. His symptoms began after a blunt abdominal and flank trauma. He had failed two transabdominal surgeries and was successfully treated at our institution with an open retroperitoneal median arcuate ligament release with relief of symptoms. This case adds open retroperitoneal MALS release as a surgical option for this complex disease. Future clinicians can draw on this case when faced with similar circumstances in patients with chronic, life-limiting abdominal pain from MALS.