What is median arcuate ligament syndrome?
In a person with median arcuate ligament syndrome or MALS, the median arcuate ligament essentially acts like a hammer and the celiac axis acts like an anvil. It compresses the major blood vessels and squeezes the nerves between them.
When the median arcuate ligament compresses too tightly against the celiac artery (a major branch of the abdominal aorta) and compresses the nerves in the area called the celiac plexus (a network of nerves in the abdomen), it can cause pain and other symptoms.
What causes MALS?
MALS is an anatomical abnormality caused by the median arcuate ligament compressing the celiac plexus nerves over the celiac artery in the abdomen. The compression of these nerves can cause significant pain.
Another cause of MALS may be due to the lack of blood flow to the organs supplied by the celiac artery, although this is a controversial theory.
What are the signs and symptoms of MALS?
Signs and symptoms of MALS may include:
How is MALS diagnosed?
Once other conditions are ruled out, your doctor may order tests to look for MALS. Diagnostic tests may include:
- Mesenteric duplex ultrasound to check blood flow through the celiac artery and compression of the celiac plexus
- Computed tomography (CT) or magnetic resonance imaging (MRI) angiogram, which can give a better picture of the celiac artery and aorta
- Blood and urine tests to rule out other diseases and to diagnose the condition
- X-rays and upper endoscopy (a test that uses a lighted scope to look inside the digestive tract)
How is MALS treated?
Median arcuate ligament syndrome can be cured with surgery, which is the only treatment option currently available. The most common surgery performed is called median arcuate ligament release or median arcuate ligament decompression, which is an open surgery but can also be done with minimally invasive techniques using laparoscopy or robotics.
The surgery is performed under general anesthesia, during which the surgeon divides the median arcuate ligament and celiac plexus. This gives the celiac artery more space, restores blood flow (revascularization), and relieves pressure on the nerves. Patients usually stay in the hospital for 2-3 days following the surgery. After a month, they undergo an ultrasound to confirm that blood flow is completely restored.
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Skelly CL, Townsend E, Mak GZ. Median Arcuate Ligament Syndrome. National Organization for Rare Disorders. https://rarediseases.org/rare-diseases/median-arcuate-ligament-syndrome/