Median arcuate ligament syndrome (MALS) occurs when the arc-shaped band of tissue in the chest area (median arcuate ligament) presses on, or traps, the artery that supplies blood to the organs in your upper abdomen (celiac artery).
The location of the median arcuate ligament and celiac artery varies slightly from person to person. Typically, the ligament runs across the largest blood vessel in the body (aorta) and sits above the celiac artery without causing problems. But sometimes the ligament or artery may be out of place, causing MALS. The ligament may also put pressure on the network of nerves surrounding the celiac artery (celiac plexus).
MALS may occur in anyone, even children. Other names for MALS are:
Treatment involves surgery to release (decompress) the ligament and restore blood flow through the artery.
Often, compression of the celiac artery doesn't cause any symptoms.
However, those with MALS can have long-term (chronic) stomach pain. Signs and symptoms of MALS include:
Your doctor may hear an abnormal sound called a bruit when listening to your upper stomach area with a stethoscope. The sound occurs when a blood vessel is blocked or narrowed.
There are many different causes of stomach pain. If you have stomach pain that continues despite home care, call your doctor. You'll need a complete physical exam and tests to determine the specific cause.
If your stomach pain is severe and activity or movement makes it worse, call your doctor immediately. Seek immediate medical help if your stomach pain occurs with other concerning signs and symptoms, including:
Sometimes upper stomach pain can be confused with chest pain. Get emergency help or call 911 if you have chest or upper stomach pain with or without any of the following symptoms, which might signal a heart attack.
Doctors aren't exactly sure what causes median arcuate ligament syndrome. The causes and diagnosis of MALS has been a subject of controversy. The signs and symptoms may be due to a lack of blood flow through the celiac artery, or compression on the nerves (neurological) of the celiac ganglion causing the pain.
Because the cause of MALS is poorly understood, the risk factors for the syndrome are unclear. MALS has been seen in children, even twins, which might mean genetics plays a role.
Some people have developed MALS after pancreatic surgery and blunt injury to the upper stomach area.
MALS complications include long-term pain, especially after meals, which can lead to a fear of eating and significant weight loss. The pain and related depression or anxiety can greatly impact your quality of life. Because MALS symptoms may be vague and mimic other conditions, it may take some time to get an accurate diagnosis.
There's no specific test to diagnose MALS. Your doctor will carefully examine you and ask questions about your symptoms and health history. The physical exam is often normal in people with MALS. Bloodwork and imaging tests help your doctor rule out other causes of stomach pain.
Tests used to rule out other conditions and diagnose MALS may include:
Surgery is the only treatment option for MALS. The most common procedure is called median arcuate ligament release, or median arcuate ligament decompression. It's usually done as an open surgery but sometimes can be done as a minimally invasive (laparoscopic or robotic) procedure.
While you're under general anesthesia, a surgeon divides the median arcuate ligament and network of nerves in the stomach area (celiac plexus). Doing so provides more room for the artery, restores blood flow and relieves pressure on the nerves.
Some people with MALS may need an open surgery to repair or replace a blocked celiac artery and fully restore blood flow (revascularization).
If you have MALS release surgery, you'll usually stay in the hospital for two to three days. You'll need an ultrasound about a month after surgery to confirm that blood flow through the celiac artery is fully restored. Several studies have shown that surgery to release the median arcuate ligament is safe, even in children with MALS. It often results in immediate pain relief and improves the person's quality of life.
Pain and stress often occur in a cycle. Pain can make you feel stressed, and stress can make pain worse. MALS pain may make it difficult to eat, exercise, sleep and do everyday tasks. Relaxation techniques, such as deep breathing and meditation, may ease pain and boost your mental health.
Living with MALS may make you feel sad, anxious or depressed. The challenge of getting an accurate diagnosis — and having so many medical tests — may be overwhelming. Sharing your thoughts and feelings with others who have similar experiences may be helpful. A support group can provide emotional support and help you learn about new coping skills. The National MALS Foundation provides information and connections for people with median arcuate ligament syndrome. Or, ask your doctor, clinic or hospital if they can recommend a support group in your area.
If you think you have stomach pain that doesn't go away, or think you may have median arcuate ligament syndrome, it's important that you make an appointment with your doctor. If median arcuate ligament syndrome is found early, treatment may be more effective.
A doctor's appointment can be brief, and there is often a lot to discuss. So it's a good idea to be properly prepared for your appointment. Writing down your list of questions or concerns is one of many steps you can take to get ready for your doctor's visit.
List your questions from most to least important, in case time runs out. For median arcuate ligament syndrome, some basic questions to ask your doctor include:
Don't hesitate to ask your doctor additional questions during your appointment.
Your doctor is likely to ask you a number of questions. Being ready to answer them may save time to go over any concerns you want to spend more time on. Your doctor may ask:
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