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Median Arcuate Ligament Syndrome (MALS)
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?
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Thank you.
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1 ReactionI live in Sweden, and I feel that the health care do not take my symtoms seouriusly, and there is not a lot of information to find.
@piapettersson - Welcome to Mayo Clinic Connect! There are quite a few members with MALS- even if it is a rare condition.
I’m Swedish too, living in US, but I have close family there. I know what you are up against with the healthcare system there.
You could check with major University Hospitals if there are surgeons familiar with MALS. Do you live close to any?
Most physicians and surgeons here are not familiar with the syndrome.
Can I help you with specific information?
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1 Reaction@hannat - I’m happy that you have a diagnosis! I also went years with abdominal pain of different intensities, thinking it was GERD or gallbladder problems. However, it got progressively worse and I was diagnosed and had surgery 6 years ago. They had to place a stent in the celiac artery after a few months since it was still compressed. Since then, I have been fine. Towards the end I had severe pain 1-2 hrs after a meal.
I preferred not to eat much each meal. I never lost weight either.
I was told that many people go through life with this without symptoms.
If you can manage the pain by the way you eat, I think you probably don’t have to have surgery.
However, it may be a good idea to get an opinion from a vascular surgeon.
Has anyone had Mals surgery, and recovered from it, only to have it come back again?
Like is it possible for Mals to come back?
I had surgery over two years ago which was successful and I got immediate relief from the majority of my symptoms. now I am starting to have the same symptoms again and I am nervous that it is back. When I had my surgery my surgeon said that bec of the specific way he operates it is not possible for it to come back. Does anyone know anything about this or have any experience with it?
Thank you!
Mine came back, but it was much less severe. I had a 2nd surgery and the surgeon found a "band of thick neural tissue" around the artery which she felt confident was the cause of renewed symptoms. I developed gastritis 2 months after this surgery which is better but not completely gone, so I worry in the back of my mind that it's still MALS and debate whether I should try to get a follow up mesenteric ultrasound.
Thank you for your reply! Did you get complete resolution of your symptoms after your first surgery? And if so how long did that last before it came back?
As I understand this surgery, it cuts the median arcuate ligament that is putting pressure on the celiac artery. There is usually immediate relief when blood flow is restored.
In my case, symptoms returned after 6 months. The artery was still kinked and could not open up. A stent was placed to keep it open. After 6 years I’m still fine.
I didn't have the same MALS pain or stomach problems for around 3 years. Then I started having the same sharp, deep pain on my right side under my ribs after exercise or in the morning after sleeping. I really didn't suspect a recurrence until I started having bouts of nausea as well. None of this was as severe but it started to interfere with my life.
There is some debate in the medical community (and thus patients) about whether MALS is ischemic (blood flow), neurogenic (nerve damage) or both. I would say the consensus now is that typically both are involved. 10-20% of the population have celiac arterial compression by the median arcuate ligament but don't have this syndrome. In my case, the first surgeon didn't cut back the ligament very much or remove much nerve tissue, so I still had compression and then pain as nerves grew back and were compressed along with the artery. At least, that's the theory of my 2nd surgeon. She felt very confident removing band of nerves and trimming back the ligament farther would fix me for good.
If you're feeling symptoms again you should probably seek out a MALS knowledgeable GI specialist or surgeon so you can get the tests redone. Or go back to your first surgeon. It could be something else of course, but no matter how confident the surgeon is, MALS can come back and need additional interventions.