Median Arcuate Ligament Syndrome (MALS)

Hi @cberry, sorry to hear you are having problems. I agree like Kari, you need a second opinion. I had an open surgery for both celiac and sma arteries. It was a big one. This was the beginning of Feb. 2014. July 2014, they noticed it narrowing again. I thought that was pretty quick. You never know you need to get a angio. I eventually got 2 stents put in and there was a lot of scar tissue. I can't bend to my left without it feeling like theres a brick or something preventing me from moving anymore : scar tissue. I again just had angio done to see how much of a blockage/stenosis there really was since the ct wasn't clear enough. Good thing, my surgeon had to balloon the celiac while in there. I do have relief of pain after eating, but still all bowel issues.
You just don't know and you need to get someone experienced. I hope that helps you understand believe in what your body tells you. Good luck

@cberry I am guessing that with robotic surgery they were not able to do a intraoperative ultrasound to check velocities after the ligament was clipped. The problem with that is that if the artery is deformed from the ligament it could still be causing stenosis. One thing to consider is having a cath angiogram and have them measure arterial pressures. You need a second opinion with a vascular surgeon who has experience with MALS. This breaks my heart! Scar tissue does not show up on imaging, but can contribute to problems. I am more concerned about the velocities of your celiac artery. Do you mind me asking what state you are in?

I went to a general surgeon and he decided to do the surgery robotically, he had never done the surgery before. He released the ligament and did the ganglionechtomy. I truly believe there is still an issue with my celiac artery being compressed however, living in a smaller city the surgeons here don't want to step on each other's toes and make one another feel bad by second guesssing someone's work and getting someone to go back in to look at it again is becoming a challenge. I have been in and out of the ER numerous times for the pain, including last night. It is to the point where even fentenyl isn't working for the constant pain. I am desperate for someone to help but I don't know where to turn. All of my labs always come back fine. No one has done a repeat Ct Angio or an ultrasound to see if the artery is still compressed. I worry about scar tissue being an issue as well considering that wouldn't show up on imaging. Would scar tissue cause pain? Any help would be appreciated. Thanks.

@cberry Welcome to Mayo Clinic Connect! I am so glad you posted. I am so sorry to hear that your pain has returned, I know how difficult it is to admit that the symptoms have returned, or never truly went away. May I ask what kind of surgery you had? Open vs Lap? Surgery is not fun, and something none of us MALS take lightly, however when your quality of life deteriorates so drastically it becomes an option that we have to consider. The risk vs benefit is something we each struggle with. I am sorry you are going through this, I was fortunate that I never had the severe vomiting some people have. I have nausea, postprandial pain, weight loss, bowel issues all of those symptoms take their toll, add vomiting and I think I would go over the edge. Thank you for being brave and sharing your experience, there are several of us here and I hope you can find some comfort knowing you are not alone.

I was diagnosed with MALS in February this year and underwent surgery to release the ligament in March. I felt somewhat better after surgery and was able to finally eat without vomiting every time I ate. I started gaining back the 38 lbs I had lost in four months. My symptoms never fully went away and the abdominal pain has continued to escalate again. I now have started losing weight again due to severe pain every time I eat and vomiting again. My GI dr started me on IBS meds but they have not helped anything. My PCP believes the problem still remains with my celiac artery and is revisiting surgical options. Although surgery is never fun, I hope they go back in and fix me up so I can feel human again and enjoy my life.

Thank you. It is really helpful that this group is here and you have been so helpful to me. I can't thank you enough!!!

Overwhelming but good news! This could be the opportunity for some relief, It sounds like your vascular surgeon is on top of this. I will be thinking of you, invasive procedures are never fun, and they can be stressful. Hang in there, you got this! 

Hi Kari, Well had the vascular surgeon appt and went over results. Imaging showed something with celiac artery, but sma was ok. Tues. I am going for the invasive angio. If he needs to do something he will do it then. Also he said that the stent in the celiac didn't go far enough into the aorta so was thinking of possibly extending that. If this doesn't help with symptoms we will discuss the celiac block like you had said. I did email him today though asking about extending the stent, and if so would that be recovery like when stents were done. I had a hematoma so that caused more time in the hospital, but otherwise I think only a 2 night stay. As for the fodmap diet, well I am going to put that off till we see what is going on with my arteries. If he does do something I want to be clear on what hopefully helped symptoms. I am also taking a 'break' from the testing after this for a bit. This is exhausting as you know.

One last thing before I go to bed! I have asked my Doctors for a testing holiday, I asked for a month off of all the testing so that I could catch my breath. They were good about obliging me. Also, not to add to your confusion, all my vascular testing (Non-invasive) came back normal. Grrrrr It was the invasive cath angiogram that showed the severe stenosis. I have heard that Ultrasound does not show stenosis unless it is at least 75-80 percent occluded... maybe someone could clarify that? Anyways, hang in there! Chat with ya soon!

@kariulrich, thanks for the info. I haven't seen that fodmap site before, but it looks good. It is so overwhelming. They need to make an app where you can scan the item and it lets you know if you can eat it or not. It is difficult to look at every ingredient. As for the article, haven't seen that one. I am always looking for newer articles for treatments, but for other info I don't think it matters so thanks. I will be reading that next. Well I am happy that the calcium blocker is helping for you. My last vascular surgeon said she didn't think any of my pain, or symptoms was from the arteries since they were patent, and that was that. It seems you have a good vascular dr. that helps you with options. Hopefully this new one will for me. I don't want more meds and tests, but I would like some relief. Especially the exhaustion, but maybe that is from all the back and forth for testing and appointments....haha....Well thanks again. YOu always have helpful info!!! I will let you know what happens at my appt.....