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Median Arcuate Ligament Syndrome (MALS)
Digestive Health | Last Active: 21 hours ago | Replies (1157)Comment receiving replies
Welcome, @ukmalsman. Mayo Clinic Connect is all about meeting other members who experience things similar to yourself, share information, and encourage one another – I'm so glad you've joined this group and shared some incredible insights.
It's interesting that you note, "Currently there is very little research into MALs with consultants looking at the condition with blinkers on unable to even agree on how the pain is caused." I agree – the diagnosis of MALS has been the subject of much debate.There are several factors (about the lack of clarity) that I thought I'd mention.
Because the cause of MALS is not clear and symptoms may persist even after surgical treatment, its diagnosis is considered controversial. The challenge lies in the fact that it mimics other GI symptoms. Therefore, MALS is considered to be a diagnosis of exclusion – every other possibility that might be causing pain must be ruled out before making a clinical diagnosis.
In MALS, the medial arcuate ligament compresses the celiac artery, reducing blood flow to the stomach/intestines; surgery, where the ligament is cut away from the artery, doesn’t always get rid of the pain and symptoms. Many surgeons reason that if compression of this artery was causing the pain and other symptoms, then eliminating the compression should get rid of it – which may not be the case.
Although, I've learned that it's become less challenging to treat, since surgical intervention now includes removing the celiac ganglion, which is the mass of nerves in that area (some call it the “solar plexus”) because pressure on the nerves may be causing the abdominal pain. https://pdfs.semanticscholar.org/d6b6/4ec69d1cd3ef5f02036362f960d3b0be0181.pdf
That being said, I'd also like to mention these very encouraging published studies that show the tremendous advancements taking place (imaging techniques, laparoscopic surgery), which would help in establishing diagnoses of this condition:
- Contemporary management of median arcuate ligament syndrome provides early symptom improvement https://bit.ly/2Rrfop4
- A predictive model for patients with median arcuate ligament syndrome https://bit.ly/2pDJQzN
@ukmalsman, if there is one thing I've learned from the members of Connect, including you, is that you should never give up until you find the right physician or the right treatment that can help you in the best possible way. I'm certain @kariulrich will join in soon, and I look forward to seeing more posts from you.
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Hi Kanaaz
Thank you for the welcome and thank you for the links to studies, I look forward to reading them. I agree with what you say, but hope that consultants don't leave looking for MALs until the very last moment. It is the very fact that MALs is considered to be a diagnosis of exclusion and every other possibility that might be causing the pain must be ruled out that worries me. 10 years ago my symptoms became chronic, for the first 3 years I could barely leave the house and I looked like a skeleton. They went by that very premise and started ruling out other things. Over the 10 years I had numerous operations i.e they took out a perfectly healthy appendix hoping it would solve the problem; it didn't. In fact I got peritonitis which nearly ended my life. Then they took out my gall bladder hoping it would solve the problem. They also performed exploratory laparotomy and found nothing. After so many operations I ended up with Adhesions which they had to open me up for twice. Even up to a few months ago they were ready to discharge me to the pain specialist for a spinal cord stimulator, but I refused to give up. It was after talking to an consultant immunologist about my symptoms he recommended the angiogram which showed the compression. The CT report stated that i was not eligible for stenting or angioplasty. I can't help wondering if like @shawbing they had seen it at the early stage 10 years ago a minor operation to release the artery from the ligament would have provided long lasting or total pain relief. My concern is if consultants continue with that line of thinking they will keep catching patient at an advanced stage where major damage has been done by the ligament and possibly the lack of blood supply. Making any surgery useless further validifying their notion that MALs is a diagnosis of exclusion; a cycle that must be stopped. They should be looking at what symptoms should be present for them to immediately do an angiogram to look at the celiac trunk. In my view ruling out everything else first is being reactive rather than proactive. Just because they don't know the cause doesn't mean it is not a real illness.
Mark