Ten female and five male patients, from 16 to 70 years of age, with the median arcuate ligament syndrome were encountered over a 31/2-year period. Surgical intervention was elected in 12 patients. Transection of the median arcuate ligament was performed in each instance, and arterial reconstruction undertaken twice. A distinctly fibrous median arcuate ligament crossing the aorta at an unusually low level was a constant finding among these patients. This anatomic situation, not an abnormally high origin of the celiac artery, was associated with compression of the celiac artery at the aortic hiatus. Demonstration of arterial entrapment is not proof of the syndrome's existence. Provocative xylose absorption tests appear to offer more objective information concerning the significance of celiac artery stenoses. These preliminary studies lend credence to speculation that the primary derangement in the median arcuate ligament syndrome is functional intestinal ischemia.