Median Arcuate Ligament Syndrome (MALS)

Hi lm Ralph, in my 1st 2 years of weight drop from about 200lbs to 119 lbs, l changed gastro. Doctors, and he put me on TPN, l receive all my nutrition from it. The line is inserted in the fore arm, virtually painless, a nurse comes to my home and services the TPN. It is not uncomfortable at all for me. Look in to it. Having an NG would be horrifying for me. You may want to have a second opinion this just doesn’t seem right to me, lm not a doctor. TPN/ Temporary Peritoneal Nutrition . Good luck and my thoughts are with you,

I’m Ralph, l am a new member, l have mals described in a written CT scan during a life emergency surgery where the UCI surgeon removed a part of necrotic intestine. Also in another CT scan evidenced the same condition. I have had many tests done, but would like to be admitted to Mayo Clinic Arizona and let them take over, since ucla and UCI of Calif. really have not the Vascular surgeons to do this ligament decompression. I’m telling my story for any one and you for help. I have been bedridden with this disease undignoised for 22 years, on TPN, with severe chronic pain. When l called Mayo they gave me an lD patient number, but unable to give me an appointment. How can l find a way into Mayo and be medically evaluated and if need be have surgery. This brings me to the ? can you explain not having vascular surgery because the numbers are too risky ? If you or anyone else has had this median arcuate ligament release surgery, l would like to know what is involved start to recovery. Thank you for listening to me, and l wish you the best during your journey back to health.

I just had surgery on November 19. As of now the nausea and throwing up have got better. But I’m still experiencing a lot of pain after I eat. Has an one else had surgery? Where do I go from here?

Dear Kari: lm Ralph, you have really helped me by your group questions. I was diagnosed with mals, in bed for 22 years and this is the cause. I’m also on TPN daily this may help you regain nutrients, and the process is not painfull so don’t worry. At least l know what’s coming up for me. I pray your journey is rewarding. Mayo would not make a appointment for me. I do not know where to turn or do, so any one out there that can help me l would appreciate it. Good luck Kari.

I’m Ralph help me lm having connecting with the FB support group. Want to join, Thank yuu Ralph

I’m Ralph, l have mals being in bed 22 years. Going thru testing. I want Mayo to do surgery. I’ll keep in contact. I have questions. In chronic pain. squirm in bed with chronic pain. No pain meds help. I’ll keep in touch, Ralph

I’m Ralph l have mals. going thru testing for l pray Mayo Arizona, will examine me and do surgery. I had a by pass then 2 recisions. Bed ridden 22years till currently. l will join your commentary, l have ?s, R

Good news! You had a proper CTA. My celiac artery was the same- it recompressed. The indentation/ angle didn’t have the strength to stay patent. Therefore, I now have a stent. It’s somewhat deformed but functions well enough. No pain!

I forgot to update here, but the CTA did indeed confirm the ultrasound:

"FINDINGS:
CTA: The abdominal aorta is normal in caliber with no evidence of aneurysm or dissection. The superior mesenteric and inferior mesenteric arteries are patent. There appears to be acute angulation of the celiac axis at its origin with narrowing compatible with median arcuate ligament syndrome."

It took the techs at this major Denver hospital 20 minutes to figure out how to make their machine say "breathe out, hold your breath" but I reiterated that we needed inhale & exhale. I looked at the slides myself and it does look like my celiac trunk gets squashed on expiration. At first I felt a sense of calm at least having a clear finding, but now the hard part is coming... trying to figure out what to do. I sent my CD off to Dr. Hsu this morning but there will be a wait of several weeks before I get to talk to him. Also there are very vocal groups on Facebook who are either hate or love the guy, so it's bit overwhelming as a prospective patient. I've also contacted Dr. Skelly and Dr. El-Hayek but both prefer lap surgery and I'm not sure if they'll even give me a consult. All I really want at this point is opinions: how/why did I recompress? Is it the ligament again, or scar tissue, and is there a lasting solution? It looks like my artery still functions when I lift the diaphragm so that suggests I don't need bypass. Also why does my SMA always show high velocities on ultrasound and then is "patent" on CTA? That concerns me.

In the meantime, I think I'm going to go ahead and pursue another celiac plexus block. This morning I woke up in pain again and it's getting exhausting.

Most of the time, the Celiac Plexus blocks don’t last very long. I found the ablation on the Splenic nerve on both sides helped me for 8-9 weeks.