BACKGROUND: Median arcuate ligament syndrome (MALS) is an uncommon cause of postprandial abdominal pain that can be difficult to diagnose, especially in children.

CASE REPORT: We report a 14-year-old male patient with 2 months of severe, stabbing periumbilical pain resistant to medical therapy. Mesenteric duplex ultrasound showed aliasing with a peak systolic velocity of 234 cm/s at the celiac origin, and computed tomography angiography demonstrated mild kinking with poststenotic dilatation, consistent with celiac trunk compression. Diagnostic fluoroscopy-guided bilateral posterior retrocrural celiac plexus block (CPB) produced rapid pain reduction, enabling a full meal within 6 hours. Analgesia persisted for about 48 hours. The patient subsequently underwent open MAL decompression and remained symptom free at 18-month follow-up.

CONCLUSIONS: Our case illustrates that temporary CPB may be a useful diagnostic adjunct to identify a sympathetically mediated pain component and help guide surgical candidacy in MALS.

KEYWORDS: Adolescent, celiac artery, celiac plexus, median arcuate ligament syndrome, nerve block