What is Median Arcuate Ligament Syndrome?

Median arcuate ligament syndrome, or MALS, occurs when the band of tissue across the upper belly region puts pressure on the artery that supplies the stomach, spleen, and liver with blood. The tissue is referred to as the median arcuate ligament. The artery is referred to as the celiac artery.

The median arcuate ligament provides a path between the chest and the belly region for the body's largest vessel, the aorta. Most often, the ligament passes over the aorta. The celiac artery rests just below the arch.

But at times, the ligament or arteries become misplaced. The ligament compresses the celiac artery and the plexus of surrounding nerves, the celiac plexus. The compression may result in MALS symptoms. In some individuals, the condition leads to severe pain in the stomach.

MALS can happen to anyone, including children. MALS has also been referred to as:

• Celiac artery compression syndrome.
• Celiac axis syndrome.
• Dunbar syndrome.

What are the symptoms of Median arcuate ligament syndrome (MALS)?

Pressure on the celiac artery may not always cause symptoms. Pressure on the nerves causes MALS symptoms.

Symptoms of MALS are:

• Tummy pain after meals or exercise.
• The tummy pain improves by leaning forward or backward or standing during meals.
• Afraid to eat food due to pain.
• Involuntary weight loss.
• Bloating.
• Diarrhea.
• Nausea and vomiting.

What causes median arcuate ligament syndrome (MALS)?

It is thought that MALS occurs from the median arcuate ligament compressing or pinching the nerves of the celiac plexus over the celiac artery. Compression of these nerves is likely to produce a pain like pain you have in your hands when you have carpal tunnel syndrome feel in their hands. A second cause of the condition could be the insufficiency of blood flowing into the organs that are served by the celiac artery, but this hypothesis is not consistent.

What is the diagnosis for median arcuate ligament syndrome (MALS)?

If your doctor suspects you have MALS, they will take a history and do a physical exam. Your doctor may also order some tests, such as blood work and imaging tests, to help exclude more common explanations for your symptoms. These include:

• Gastroesophageal reflux disease (GERD).
• Gastritis.
• Gastroparesis.
• Issues with your pancreas, liver, gallbladder, spleen, or intestines.

After eliminating other possibilities, your doctor may order a mesenteric duplex ultrasound to assess blood flow in the celiac artery and check for celiac plexus compression. A CT or MRI angiogram can also provide a clearer view of these areas.

If MALS is suspected, your medical records will be reviewed, and additional imaging tests may be ordered, such as a mesenteric ultrasound or CT/MRI angiogram. You'll consult with surgeons specializing in minimally invasive or vascular surgery, and a pain management specialist may evaluate you for a celiac plexus block procedure to offer temporary symptom relief and help confirm the diagnosis.

What is the treatment for median arcuate ligament syndrome (MALS)?

Surgery is the only treatment for median arcuate ligament syndrome, also called MALS. Surgery for MALS can improve or reduce symptoms in most people.

The most common surgery involves releasing the median arcuate ligament, also referred to as decompression. It's typically performed as open surgery by making an incision in the abdominal region. Occasionally, it is performed with a camera and tiny instruments inserted through a few small incisions. This is termed laparoscopic surgery.

During decompression surgery, the doctor removes sections of the median arcuate ligament. This lowers pressure on the celiac artery and nerves. The doctor removes nerves surrounding the celiac artery and its branches. Nerve bundles on both sides of the celiac artery also may be removed.

A few individuals with MALS also might require surgery to fix or replace a clogged celiac artery and improve blood flow.

If you've had MALS release surgery, you typically can stay in the hospital for 2 to 3 days. You might get an ultrasound or a CT scan a month or so after surgery to ensure blood flow is restored completely. You might need to visit a nutritionist to assist with getting back to a regular diet. This is especially beneficial if you're not eating at all or have lost a significant amount of weight.

What kind of follow-up is required after median arcuate ligament syndrome (MALS) surgery?

Most people with MALS undergo a duplex ultrasound one month following surgery to ensure that there is no continued compression of the median arcuate ligament. Some individuals still experience celiac artery narrowing due to scar tissue formation. This typically does not present with symptoms post-operatively and can be managed with non-surgical methods like medicines or, occasionally, another celiac plexus block. Every now and then, other endovascular treatments like celiac axis stenting may be required.

A few individuals with recurrent episodes of MALS could be candidates for a repeat procedure of scar tissue release. These are at significantly greater risk (greater than 50%) of requiring an open operation (with a vascular surgeon's help).

Why choose Tender Palm Super-Speciality Hospital for Median Arcuate Ligament Syndrome (MALS) Treatment in Lucknow, India?

Tender Palm Super-Speciality Hospital offers advanced Median Arcuate Ligament Syndrome (MALS) treatment in Lucknow, India, at an affordable cost. We have a team of experienced vascular surgeons and gastroenterologists who provide accurate diagnosis and both non-surgical and surgical treatment options including ligament release, celiac artery decompression, and comprehensive vascular rehabilitation procedures. Our Vascular Surgery and Gastroenterology team has decades of experience in successfully treating Median Arcuate Ligament Syndrome (MALS) in Lucknow, India.

To seek an Experienced Median Arcuate Ligament Syndrome (MALS) Treatment in Lucknow, India:

Call us at +91-9076972161
Email at care@tenderpalm.com

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