Median Arcuate Ligament Syndrome (MALS)

@artistgma nausea can be a problem if you are advancing your diet too fast. Also the pain medication can contribute to nausea. I would use Reeds Ginger Ail in between meals, or following a meal. You need to eat 8-10 very small meals a day starting out, and advance very slowly. It was at least a year before I could tolerate eating 3 meals a day, even then sometimes I apt for more frequent smaller meals. Eating things that easy to digest, I would have white toast and malt a meal. What types of food are you eating? Are you eating and drinking fluids at the same time?

I am looking for support from those who have had this surgery. I had mine on March 30 and am struggling with the continued nausea. I had open surgery....not fun!

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.

http://www.thij.org/doi/full/10.14503/THIJ-12-2495?code=txhi-site
Article Citation:
Fernando Vazquez de Lara, Christopher Higgins, and Eduardo A. Hernandez-Vila (2014) Median Arcuate Ligament Syndrome Confirmed with the Use of Intravascular Ultrasound. Texas Heart Institute Journal: February 2014, Vol. 41, No. 1, pp. 57-60.
doi: http://dx.doi.org/10.14503/THIJ-12-2495
Case Reports
Median Arcuate Ligament Syndrome Confirmed with the Use of Intravascular Ultrasound

Fernando Vazquez de Lara, MD, Christopher Higgins, MD, and Eduardo A. Hernandez-Vila, MD, FACC
Address for reprints: Eduardo A. Hernandez-Vila, MD, FACC, 6624 Fannin St., Suite 2870, Houston, TX 77030
E-mail: eduardohernandezmd@gmail.com

Median arcuate ligament syndrome, a rarely reported condition, is characterized by postprandial abdominal pain, nausea, vomiting, and weight loss. Its cause is unclear. We present the case of a 45-year-old woman who had intermittent chronic positional abdominal pain without weight loss. Magnetic resonance angiograms and computed tomograms revealed stenosis of the celiac artery. Ostial compression was confirmed on catheter angiographic and intravascular ultrasonographic images. Intravascular ultrasound revealed far greater stenosis than did the initial imaging methods and confirmed a diagnosis of median arcuate ligament syndrome. In lieu of surgery, the patient underwent a celiac ganglion block procedure that substantially relieved her symptoms.

To our knowledge, this is the first report of the use of intravascular ultrasound in the diagnosis of median arcuate ligament syndrome. We recommend using this imaging method preoperatively in other suspected cases of the syndrome, to better identify patients who might benefit from corrective surgery.

Keywords: Abdominal pain/etiology, arterial occlusive diseases/diagnosis/pathology/physiopathology, celiac artery/pathology/physiopathology/ultrasonography, constriction, pathologic, diagnostic imaging, ligaments/pathology, mesenteric vascular occlusion/complications/etiology, ultrasonography, intravascular

© 2014 by the Texas Heart® Institute, Houston

Hi @evrose23! After discussion with my vascular surgeon, open procedure was the only option for me. I have an underlying vascular disease and laporoscopic would have put me at a greater risk. I believe that there is better visualization in the open procedure vs laparoscopic, and it really depends on the patient's age and how long they have been diagnosed. Children are a whole different story, and laparoscopic seems to have a great success rate. For me, my artery did not open up after the ligament release so I had to have a bypass done. Let me know how your CTA goes!

@kariulrich Hello, I'm about to have a CT-A to determine if I have MALS. Do you mind if I ask why you chose the open procedure vs. laparoscopic?

Kari, thanks for sharing your video about living with Fibromuscular Dysplasia (FMD) and MALS. First-hand stories mean so much.

This was my experience with MALS and FMD done by Mayo in 2011, I have had a revision to my celiac bypass since then, and I am doing well. http://sharing.mayoclinic.org/discussion/before-and-after-fibromuscular-dysplasia-fmd-diagnosis/

Very interesting! I would like to hear, see & read more about this. Thank you fir sharing, Good job!
Linda

Interesting article: http://www.thij.org/doi/full/10.14503/THIJ-12-2495?code=txhi-site