Median Arcuate Ligament Syndrome (MALS): Symptoms & Diagnosis

Overview

• Definition: MALS is a rare condition where the median arcuate ligament compresses the celiac artery and nearby nerves.
• Symptoms: Intense upper abdominal pain, especially after eating.
• Treatment: Typically surgical, involves separating the ligament from the celiac artery.

Anatomy & Pathophysiology

• Median Arcuate Ligament: Shaped like an arch, normally positioned above the celiac artery.
• Celiac Artery: Major branch of the aorta, supplies blood to the abdomen.
• Issue in MALS: Ligament is lower, pressing on the artery, restricting blood flow and putting pressure on nerves.
• Aliases: Also known as Celiac artery compression syndrome, Celiac axis compression syndrome, Dunbar syndrome.

Symptoms and Causes

• Key Symptoms:
  • Upper abdominal pain post-eating.
  • Bloating, diarrhea, nausea, vomiting.
  • Significant weight loss (>20 pounds).
• Potential Causes:
  • Congenital misplacement of the ligament.
  • Post-surgical or traumatic abdominal changes.

Diagnosis and Tests

• Diagnostic Approach:
  • Review of medical history and physical exam.
  • Blood tests: CBC, metabolic panel, liver function, SED rate/CRP, thyroid tests.
  • Imaging: Abdominal ultrasound, small bowel follow-through, Upper GI series.
  • Procedures: Colonoscopy, EGD, motility studies.
• Advanced Testing:
  • Angiogram, CT scan, MRI, mesenteric duplex ultrasound.

Management and Treatment

• Initial Management:
  • Celiac plexus block for pain relief.
• Surgical Treatment:
  • Median arcuate ligament release to relieve compression.
• Healthcare Team:
  • Involves gastroenterologists, surgeons, pain management specialists, psychologists, dietitians.

Prognosis

• Outcomes:
  • Surgery often provides symptom relief.
  • Recurrence possible; monitoring for symptom return advised.

Living With MALS

• Post-Surgery:
  • Monitor for symptom recurrence.
  • Early detection of changes discussed with healthcare provider.

Additional Information

• Mental Health: Chronic pain from MALS may lead to depression, anxiety.
• Cleveland Clinic: Offers comprehensive care including diagnosis, management, and surgery for MALS.