Hypoglycemia associated with median arcuate ligament syndrome surgery.

We present a patient who developed symptomatic hypoglycemia following surgical treatment for median arcuate ligament syndrome (MALS). The patient experienced predominately postprandial hypoglycemia after higher carbohydrate meals. Clinical findings revealed postprandial hyperinsulinemic hypoglycemia possibly related to celiac ganglionectomy performed during MALS surgery and non-insulin-mediated fasting hypoglycemia likely because of poor glycogen stores from restricting carbohydrates. Management consisted of dietary counseling, continuous glucose monitoring, and acarbose administered with meals. Following intervention, continuous glucose monitoring demonstrated improvement in hypoglycemia and overall improved glycemic stability. To our knowledge, this represents a novel report of hypoglycemia occurring after MALS surgery, highlighting a previously underrecognized metabolic consequence of celiac ganglionectomy.