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Median Arcuate Ligament Syndrome (MALS)

Digestive Health | Last Active: 1 hour ago | Replies (1229)
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@kariulrich

http://www.practicalgastro.com/pdf/February15/Median-Arcuate-Ligament-Syndrome.pdf
Richard W. McCallum, MD, FACP, FRACP (Aust), FACG
Median Arcuate Ligament Syndrome

Median arcuate ligament syndrome is an uncommon disorder rst described in the 1960s. It is characterized by epigastric abdominal pain accentuated by meals and weight loss associated with nausea, vomiting and gastroparesis. Abnormal gastric electrical rhythm has also been reported. Abdominal bruit is a striking feature that is present in some cases. It is a diagnosis of exclusion that should be considered when there is a subjective presentation of severe epigastric and right upper quadrant abdominal pain which is out of proportion to objective ndings. Whether using Doppler study, CT angiography, MRA or angiography, the main and most important goal is assessing both inspiratory and expiratory phases of the celiac artery to demonstrate reduction in the compression during inspiration. The treatment is surgical release of the median arcuate ligament to achieve decompression of the celiac artery and the celiac plexus. An evolving role for endoscopic ultrasound both in diagnosis and management is also discussed.

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coffeelatte | @coffeelatte | May 10, 2017

Hi Kari. I am 59 years old and was just diagnosed with MALS on Monday (two days ago) after having many tests run over the past year by my PCP and my GI doctor. After a year and no diagnosis, I went to Ohio to get second opinion at the Cleveland Clinic where it was confirmed with a Doppler Ultrasound and a CT Angiography after the doctor heard a bruit in my abdomen. I have severe stenosis of the celiac artery (368). However, the surprising thing is, I do not have the type of pain the vascular surgeon typically sees with MALS patients. I have had some pain, on and off, for the past four years under my right rib, but it is mild. For me, the symptoms that make me miserable are: gas pain, bloating and slight nausea. I also have malabsorption and have lost about 10 pounds due to getting full so quickly. I was wondering if you or anyone else on this board have gas or indigestion as a symptom of MALS? I am so scared to do the surgery, it is all very overwhelming right now. Thanks

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Kari Ulrich, Alumna Mentor | @kariulrich | May 10, 2017

@coffeelatte very nice to meet you! I think every MALS patient is a bit unique in their pain and the exact location. I was just speaking with another MALS/FMD patient tonight and we discussed how there is the pain and then there is also GI problems that go along with the MALS that seem to linger on for many MALS patients after the surgery. Many of us report malabsorption issues to our physicians both before and sometimes after the surgery. For me the surgery stopped the severe pain that I experienced after eating and during exercise. I still deal with GI motility issues, however they have been under control with the use of fiber and probiotics. Gas and bloating before surgery was severe and after surgery are manageable. Surgery is a big commitment and the recovery time is long, depending on the type of surgery. There is not a "text book" case for MALS... so it does not surprise me your symptoms maybe different. Here are some questions to think about: Are your symptoms affecting your quality of life? Have you avoided situations because of your symptoms? Have you and your physician tried every possible treatment? It is very overwhelming, but you are not alone in this! Learn everything you can and make an educated decision either way. How is your family taking this? Do you have support?

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