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.

@bfort

Its 6 months now for after my nMALS surgery and I may need a stent. Do you have any pain after the stent surgery from where the MALS pain was? I hate to have to go under another Surgery to wake up with the same pain again. So glad you are feeling good. Praying you continue this new journey of being pain free. ❤️🙏

Jump to this post

@bfort - The stent placement is a fairly easy procedure. I was half awake- they call it conscious sedation.
I was a little sore for a couple of days, but the other pain is gone!

REPLY
@astaingegerdm

@bfort
After my MALS surgery 2015 I was fine until 6 months later when pain returned. I had my first stent then. Fine for 7 years, now had second stent. All fine.

Jump to this post

Its 6 months now for after my nMALS surgery and I may need a stent. Do you have any pain after the stent surgery from where the MALS pain was? I hate to have to go under another Surgery to wake up with the same pain again. So glad you are feeling good. Praying you continue this new journey of being pain free. ❤️🙏

REPLY
@bfort

Thanks for posting! I'm trying to make up my mind about having it done or not. I'm almost 6 months Post op from nMALS with no relief.
Not sure what to do.

Jump to this post

@bfort
After my MALS surgery 2015 I was fine until 6 months later when pain returned. I had my first stent then. Fine for 7 years, now had second stent. All fine.

REPLY
@astaingegerdm

@annief -
Congratulations on your colonoscopy! I had my latest- and last one I hope, 2021.
It’s a very good order you got to follow up with your doctor in a month- especially since your IBS symptoms seems excessive.
I’m now 2 weeks out from my stent procedure and I am so pleased that all my debilitating symptoms are gone! I’m still fatigued, but not as bad as before. The entry was in the groin.
I would definitely do this again if I had to!

Jump to this post

Thanks for posting! I'm trying to make up my mind about having it done or not. I'm almost 6 months Post op from nMALS with no relief.
Not sure what to do.

REPLY

@annief -
Before my stent procedure I was told that many of my symptoms may disappear. It has been a slow process, very confusing, and I did not have severe pain until a while before the stent.
I had reflux, gastritis, nausea, bloating, feeling full after a few bites and the fatigue. All of these due to stenosis of the celiac artery.
My gastroenterologist wanted to perform an endoscopy anyway to make sure nothing suspicious was lurking. All was well.
So- it’s very good that you will have follow ups!

REPLY
@astaingegerdm

@annief -
Congratulations on your colonoscopy! I had my latest- and last one I hope, 2021.
It’s a very good order you got to follow up with your doctor in a month- especially since your IBS symptoms seems excessive.
I’m now 2 weeks out from my stent procedure and I am so pleased that all my debilitating symptoms are gone! I’m still fatigued, but not as bad as before. The entry was in the groin.
I would definitely do this again if I had to!

Jump to this post

So happy your stent has helped. The fatigue and random pain I have and the fact that I don’t have an appetite and can’t eat big meals has me thinking not IBS. I know my nerves are gone from the surgery so I assume that’s why I do not have the pain in the same area I did before. But, I am going to focus on de-stressing since my doc thinks that’s what’s causing my symptoms and see him in a month. Who knows, I have been under a lot of stress so I hope he is right. 🙂

REPLY

@annief -
Congratulations on your colonoscopy! I had my latest- and last one I hope, 2021.
It’s a very good order you got to follow up with your doctor in a month- especially since your IBS symptoms seems excessive.
I’m now 2 weeks out from my stent procedure and I am so pleased that all my debilitating symptoms are gone! I’m still fatigued, but not as bad as before. The entry was in the groin.
I would definitely do this again if I had to!

REPLY
@astaingegerdm

@annief
Thank you for your kind words.
I’m very happy that you have recovered from your surgery!
When I first started my journey to find help for my abdominal symptoms I was a mess! Nothing made sense. Doctors locally could not help me so I went to Mayo Clinic. Even there they were confused, but knew something was wrong. Eventually, it turned out that I had two unusual problems. One was MALS and the other was an autoimmune unusual condition. I had the MALS surgery first and later I was treated for the autoimmune condition.
I was fine for some years until a couple of years ago when I thought the autoimmune illness was back. I guess it was a coincidence that MALS symptoms also returned.
I now have an amazing internist- he helps me plan what to do to get better. I tried another GI in a neighboring city, but it didn’t work out- ended up seeing PAs all the time.
My internist then referred me to another GI with excellent credentials- equals long waiting time. It was worth the wait- I just had an endoscopy. A few days before I had a vascular procedure to place another stent in the celiac artery- seems to work well.
My internist also referred me to this vascular surgeon.
As you see, I started over with new specialists.
If you have new GI symptoms try to find an excellent gastroenterologist. Do you have a primary care doctor that can help you search? Your best bet is to go to a university medical center. Many doctors, specialists too, don’t know much about MALS. They have to be able to know what might be new MALS symptoms vs other GI problems. For example, my new GI doctor recognized that many of my symptoms may clear up after the stent was placed. However, one symptom worried him and it did not belong in the MALS related symptoms. The concern was cancer, that’s why the endoscopy. Results good, still waiting for pathology.
I hope I have encouraged you to find new doctors, either by yourself or with a primary care doctor helping you.
Either way I think you should go to a university medical center- your best chance of finding competent specialists.
Let me know what you plan to do!

Jump to this post

The stent option sounds so encouraging. Just read on one of the FB groups of someone who is remarkably better after a stent. Is your still working? That sounds like such an easy solution compared to the surgeries. Did they go through your groin to do the stent? Had a colonoscopy yesterday and things could not look better. Cleared for another 10 years which is great news. But my symptoms are blamed on IBS. I have had IBS flares but not like this. So I will follow the doctors orders and see him in a month.

REPLY
@astaingegerdm

@annief
Thank you for your kind words.
I’m very happy that you have recovered from your surgery!
When I first started my journey to find help for my abdominal symptoms I was a mess! Nothing made sense. Doctors locally could not help me so I went to Mayo Clinic. Even there they were confused, but knew something was wrong. Eventually, it turned out that I had two unusual problems. One was MALS and the other was an autoimmune unusual condition. I had the MALS surgery first and later I was treated for the autoimmune condition.
I was fine for some years until a couple of years ago when I thought the autoimmune illness was back. I guess it was a coincidence that MALS symptoms also returned.
I now have an amazing internist- he helps me plan what to do to get better. I tried another GI in a neighboring city, but it didn’t work out- ended up seeing PAs all the time.
My internist then referred me to another GI with excellent credentials- equals long waiting time. It was worth the wait- I just had an endoscopy. A few days before I had a vascular procedure to place another stent in the celiac artery- seems to work well.
My internist also referred me to this vascular surgeon.
As you see, I started over with new specialists.
If you have new GI symptoms try to find an excellent gastroenterologist. Do you have a primary care doctor that can help you search? Your best bet is to go to a university medical center. Many doctors, specialists too, don’t know much about MALS. They have to be able to know what might be new MALS symptoms vs other GI problems. For example, my new GI doctor recognized that many of my symptoms may clear up after the stent was placed. However, one symptom worried him and it did not belong in the MALS related symptoms. The concern was cancer, that’s why the endoscopy. Results good, still waiting for pathology.
I hope I have encouraged you to find new doctors, either by yourself or with a primary care doctor helping you.
Either way I think you should go to a university medical center- your best chance of finding competent specialists.
Let me know what you plan to do!

Jump to this post

Thanks for the encouragement. Thankfully my GP was determined the first time around. I will still need her but I would like to get with an experienced team if I have to go down that road. Going out of state does not seem feasible for me financially. I’ll keep you posted.

REPLY
@astaingegerdm

@bfort
I had MALS surgery 1/2015. The ligament was cut as well as many of the nerves in celiac plexus.
6 months later the symptoms returned and I had first stent placed. They said the celiac artery was still very compressed due to the ligament pressure. I was followed annually for a while. The artery with stent was still deformed, but blood flow was good- until recently. Before another procedure a week ago I was more miserable than ever for a few months and lost weight due to not eating much. A new stent was placed. I’m still waiting to hear details next week.
Slowly I’m having less and less symptoms and can eat more now.
The surgeon didn’t guarantee a good outcome- just like they did not do at my first surgery. I never hesitated going ahead- there was minimal quality of life.
An open revascularization is another option mentioned that might be necessary.
I would do that too if this doesn’t work.
These decisions are difficult to make, especially if someone has other serious medical problems.
I’m 78 and I have other health conditions that might worsen and might make me a worse surgical candidate.

Jump to this post

Thanks for responding. I love your positive attitude.
I'll keep you in my prayers for continued success and feeling be better each day.
I'm submitting all my tests to Dr Hsu for further evaluation.
Then I'll decide about the stent surgery. 🙏🙏

REPLY
Please sign in or register to post a reply.