Median arcuate ligament syndrome (MALS), also known as celiac artery compression syndrome, is a rare vascular and neurogenic disorder caused by external compression of the celiac artery and surrounding neural structures by the median arcuate ligament. It typically presents with postprandial abdominal pain, nausea, and weight loss and is most commonly reported in females between the third and fifth decades of life. We present an unusual case of a 20-year-old male with persistent postprandial abdominal pain for years who lost 20 pounds over the past year. He was found to have greater than 70% celiac artery stenosis on mesenteric duplex ultrasound, with elevated peak systolic velocities consistent with hemodynamically significant compression. Additional imaging demonstrated no significant biliary obstruction but identified gallbladder sludge, contributing to diagnostic complexity due to overlapping symptom profiles. The patient underwent simultaneous robot-assisted median arcuate ligament release with celiac plexus neurolysis and robot-assisted cholecystectomy. The procedure was completed without complications, with minimal blood loss and rapid postoperative recovery. The patient experienced prompt resolution of symptoms and was discharged in stable condition on postoperative day one. This case highlights an atypical demographic presentation of MALS and demonstrates the feasibility and safety of performing concurrent robotic procedures to address coexisting abdominal pathology in a single operative session. Increased awareness of atypical presentations may reduce diagnostic delay, while robotic-assisted approaches may offer a precise and effective minimally invasive treatment strategy for carefully selected patients.
