The Coexistence of Median Arcuate Ligament Syndrome and Gastric Cancer.

Median Arcuate Ligament Syndrome (MALS), involving celiac artery compression by the median arcuate ligament, predominantly affects young women. Symptoms include postprandial abdominal pain and weight loss. Diagnosis requires imaging; surgical decompression is reserved for refractory cases. Management remains controversial. A 60-year-old man (body mass index: 21.7 kg/m2) presented with 6 months of epigastric bloating, regurgitation, and heartburn. Endoscopic biopsy confirmed gastric adenocarcinoma. Contrast-enhanced Computed Tomography (CT) revealed gastric wall thickening, splenomegaly with infarction, and severe celiac artery origin stenosis. Vascular computed tomography angiography confirmed MALS, showing aortic-origin celiac stenosis, dilated hepatic artery, and Superior Mesenteric Artery-gastroduodenal collateralization. Endoscopic ultrasound was not performed. He underwent radical total gastrectomy with D2 lymph node dissection, MALS release, and splenectomy, with intraoperative MALS confirmation. This is the first reported case of MALS coexisting with gastric cancer. While the coexistence may be coincidental given the rarity of both conditions, it raises a hypothesis regarding a potential pathophysiological link.