Median Arcuate Ligament Syndrome (MALS)

Posted by Kari Ulrich, Alumna Mentor @kariulrich, Dec 26, 2016

I am looking for other patients that have been diagnosed with Median Arcuate Ligament Syndrome. Although it is caused by compression of the celiac artery many people experience abdominal pain after eating, diarrhea, food avoidance. Usually the first doctors they see are GI doctors. It is a diagnosis that is made after everything else is ruled out. I am curious if anyone else has had surgery?

Interested in more discussions like this? Go to the Digestive Health Support Group.

@sclindajanssen

We just published my case. In a nut shell, hip dysplasia caused lumbar lordosis which caused my MALS. Had mal surgery at Mayo Rochester with relief of more than 30 symptoms. Hip arthritis worsened lumbar lordosis and MALS symptoms started to return. Hip replacement enabled me to do exercises to straighten my spine, which reduced MALS symptoms. This is the only article in the world that presents multiple management strategies for MALS symptoms. https://www.ejcrim.com/index.php/EJCRIM/article/view/1605/2056

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Incredible. Thanks for sharing

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I just found out recently that I have to have this surgery done for MALs, I’m 29 married with 2 children and just want to know how was the coping after surgery? Will I be out of work for a long period of time? What can and can’t I do? I have so many questions, supposed to meet with the surgeon soon to go over everything I guess I’m just nervous, and also anyone have this surgery with valvular heart disease?

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@jashetta - Hi and welcome to MALS group! I found this group after my MALS surgery 5 years ago. I was surprised to find so many of us.
The surgery for me was laparoscopic, but I was told that it may become open if there is a vascular problem. They were able to do surgery through laparoscopy. Recovery time was quick for me- the pain was gone and the only discomfort I had was due to the technical aspects of surgery.
I was 71 at the time- I also have floppy valves. You should check with your cardiologist if you need any special meds.
The very important question you should have for the surgeon is how many he/she has performed. Please get back to us with more details after you meet with the surgeon!

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@kariulrich

@lmtuska, Nice to meet you! I have had 2 MALS surgeries done at Mayo, and would be happy to share any information that would be helpful. Mals in the pediatric population may be a bit different than the adult population. My experience is a bit different as I have an underlying vascular disease. There are two approaches to MALS surgery, laparoscopic and open. I would recommend asking about the pros and cons of both. It sounds like you have opted for the open approach. The open surgery is a long recovery time, for me it was at least a year. This is a small list of things that helped me:

Open MALS Helpful Hints

• No perfume, lotion, hairspray, fabric softener (Smells really bothered me after surgery)

• Needs: 1 size larger underwear and socks, slip on shoes
Loose fitting comfy yoga pants
Undershirt soft to protect clothes from rubbing against the incision

• Several travel size pillows

• Wash everything in dreft before using (My skin was sensitive)

• Unscented lotion for back rubs

• Ice pack help for back pain

• Electronic chair (If you can afford purchasing one, I highly recommend it) Great for sleeping in the first few months or more.

• Foods malt o meal good, pudding, white toast, popsicle, anything easy to digest

• Mask and headphones or ear plugs

• Something from home, small, a stuffed animal anything to keep with you

• Eat slow, very slow If you think you are eating slow eat even slower. Advance diet slowly, VERY SMALL PORTIONS. Use your iPhone during dinner to keep you entertained, yes you should be eating that slow. Eat 1/2 of what you think you can eat. After surgery, there is no longer post prandial pain and your body is malnourished so it is easy to over eat and the fact you want to eat is an amazing feeling in itself. 

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I am having my surgery next week at Mayo can you tell me how long you were in the hospital after yours.

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@melodie315 - Hi! I see you responded to a post by @kariulrich about surgery. The post you are referring to is from 2017 and Kari has not been active in the group for quite a while- don’t know if she gets the messages.
The hospital stay is usually not more than a couple of days, unless there is something special to monitor.
I stayed a couple of days extra after surgery because I had to be observed for something different. I felt fine when I left.
Good luck to you at Mayo! You will be in good hands. Please report back to us when you feel up to it.

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I have sent all my records to be reviewed my the MALS team. The only images I could not get were my mesentaric ultrasounds (2 different dates). My previous surgeon does not keep ultrasound images for some strange reason. They have the reports, several CTA images, a recent angiogram set of images. All show recompression (I had surgery in Nov 2018) and I had a block done last week which was successful. I called the triage for vascular last week and explained it is impossible to get the ultrasound images. They called me today to tell me they will not be able to review my case because of these images not being available. They have everything else they need that shows recompression and because of ultrasound images they won’t even review the case? Is there anything I can do? Is this the way the Doctors at Mayo treat those who need their help? I am angry and frustrated and appalled. Should I just move on?

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Hi @andiksu, I wanted to welcome you to Mayo Clinic Connect and tell you that I completely understand your anger and frustration. The last word you want to hear when you are sick or in pain is "Can't"!

Please be assured that Mayo Clinic would want you to feel comfortable and confident about your review for care and your experience with Mayo. I’d sincerely encourage you to visit the Office of Patient Experience website https://www.mayoclinic.org/about-mayo-clinic/patient-experience Here you will find the number below and speak to an agent who will be your advocate for making sure your needs are heard.

Mayo Clinic Office of Patient Experience
Phone: 844-544-0036 (toll free)
Fax: 715-838-5999
Email: opx@mayo.edu

@andiksu, you will notice that I did move your discussion to a long standing conversation about MALS so that you could find other support from patients who have the same diagnosis. Will you let me know if you contact the office of patient experiences?

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@tlk

Is this group still active?

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Hi tlk @tlk

I believe the group is still active although it has been a good few months since I was on. Is there a question you have for the group?

Mark

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@andiksu

I have sent all my records to be reviewed my the MALS team. The only images I could not get were my mesentaric ultrasounds (2 different dates). My previous surgeon does not keep ultrasound images for some strange reason. They have the reports, several CTA images, a recent angiogram set of images. All show recompression (I had surgery in Nov 2018) and I had a block done last week which was successful. I called the triage for vascular last week and explained it is impossible to get the ultrasound images. They called me today to tell me they will not be able to review my case because of these images not being available. They have everything else they need that shows recompression and because of ultrasound images they won’t even review the case? Is there anything I can do? Is this the way the Doctors at Mayo treat those who need their help? I am angry and frustrated and appalled. Should I just move on?

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Hi @andiksu

Hope you are well. I read your post and can sympathise with your situation. The first thing I would say to you is 'DON'T GIVE UP,' keep the dialogue going. If I was to tell you the number of times I came against roadblocks just to get to my diagnosis this post would be pages long. Short version is it took nearly 8 years to get a diagnosis. On that journey I was accused of being Mentally ill, over reacting, over sensitive to minor pain, even having Munchausen. Before being diagnosed the pain specialist was pushing for me to get a spinal cord stimulator. If I agreed that would have been the end of any investigation into the severe pain I was experiencing. I knew there was something causing the pain even though the doctors said I had every test to show there was nothing wrong.

I didn't give up and declined the stimulator. I had just started to make the connection to intensity of pain and foods eaten. I was under the care of a gastroenterologist and seeing other specialists too. I mention the food connection to all, it was an immunologist who suggested an angiogram to look for compression. He said it was too rare and highly probable it wasn't it. It took four months of fighting with the gastro doc just to get the angiogram who kept telling me it was a waste of time and money. In the end he yielded, probably to shut me up, only to find I had MALs. He had no idea how to treat it so I searched for surgeons who do. There were only 4 surgeons in the whole of the UK that had any experience, the closest being in a city 2 hours away. He was brilliant, I had a few consultations in 2019 and was booked in for the surgery first week of April 2020.

I was relieved, not only did I have a diagnosis, but I had surgery booked, which could relieve the relentless pain I was feeling. I had everything planned, how I was to get there, staying with family in the city after the surgery and how I would get back. 5 days before the surgery I got a phone call saying the surgery had been cancelled. Covid-19 had hit and taken over.

Since April I've been battling on. If there were stages to MALs I'm guessing I am in the final stages. The fight between nutrition and pain management is always a problem especially if there has not been any surgery. There were certain foods I could eat that didn't send the pain into overdrive; however, week to week the list grew smaller. Now there is nothing left on that list.

My battle now is reducing the weight loss to its minimum, but it is extremely hard as I have lost 6kg in 3 months. I won't give up, must keep going until I am able to have the surgery.

Don't stop asking for help, the medical industry is focused on one thing at the moment but it will not always be. Things do and will get better even if it is not at the pace you are expecting. There are many stories in this post, many similar to yours and some more positive. I would consider @kariulrich a positive story. It was inspirational to me as I had seen how @kariulrich had regained some of her life after surgery and was doing some of the things I would love to do like horse riding.

Keep us informed

Mark

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