Median Arcuate Ligament Syndrome (MALS)

Hi, I had Mals surgery in Jan. 2020. There’s an amazing group on Facebook called MALS Awareness. They guided me through symptoms, testing, general information and post surgery. I highly recommend them as support.

Hi, I have been diagnosed with MALS but there is not a lot of information to find. I was wondering if anyone have had problems with a burning backpain?

Good morning all. I am now past the 3 month mark and still having a rough go of it with my stomach. My endoscopy came back reporting reactive/chemical gastritis, moderate grade - likely from taking too much ibuprofen after surgery. It's been a very frustrating month because my morning stomach upset has returned despite taking Protonix. It's still relieved by Tums, but lately I can't fall back asleep. I worry a lot that either it will become "chronic" and never go away (because on this forum you'll find people who seem to have it permanently) or that it's MALS again. Last week I felt pain and a tender spot under my ribs, very close to where the MALS pain was, and it freaked me out pretty bad. I tried to get in to see a therapist but wouldn't you know it, they wouldn't take my insurance.

From a rational perspective, the stomach issue doesn't seem to be from MALS. It's very consistent with the symptom pattern of gastritis, i.e., empty stomach pain, food actually makes it feel better as long as it's not acidic. Why it's taking so long for my stomach to heal from NSAIDs, which I haven't taken in almost 2 months, is baffling and discouraging. As for the pain, it also seems to be muscular or diaphragm related. If I rub it, it gets better, and if I stretch out my right side it feels better. If I breathe with my diaphragm I feel it on inspiration, then it fades. Because this was my 2nd surgery I'm just full of doubt and fear that it will come back, but it's probably too soon to get another duplex ultrasound done, especially when the symptom pattern is inconsistent with MALS.

Basically I'm hoping I've just hit the 3rd month slump post surgery that many MALS patients talk about. I'm really hoping that when I get to month 4, things will be looking more positive for me.

Thank you for the information. It is hard not knowing what can possibly happen. I am going to push to find a doctor who will help me with this. My first doctor seems to be too busy.

Yes, unfortunately it can recompress. A number of things can happen, depending on what the surgeon did and didn't do, and your specific case. In my case, scar tissue formed around the artery, so I had the same pattern of compression on ultrasound as shown prior to surgery. When I was operated on a 2nd time, the surgeon also found a mass of neural tissue compressing the celiac trunk, which she removed, and divided the ligament an additional 2 cm apart. My first surgeon probably just didn't do enough. Overall I am doing better after this 2nd surgery but I worry constantly about it coming back with every twinge of pain.

Another issue that I have heard about is the artery can fail after years of compression, which would require a stent or bypass. Others on this forum can tell you more about that.

Hello. I am new to Mayo Connect. Back when I had my MALS surgery there was not much known about it. I am happy to see this group. I have been trying to contact my doctor in Rochester with no luck to get some answers. It has been about ten years since my surgery and I am having symptoms again. The syndrome was new back then so I wasn't told a lot about what to expect in the future. I am wondering if my artery can recompress again? Any info would be helpful.

That’s what my doctor has me setup to do. Anticoagulant meds, which causes me to have red pin like dots all over my chest neck and arms. Not sure why. Have a follow up with US in 4-6 weeks. But feeling back to my old self so I’m hopeful it stays that way. Thanks.

@jayson - I went 4-5 years for annual CT. I was also taking anticoagulant for a couple of years- because of the stent.
At my last visit there, I was told that if I needed more stent evaluation they had improved ultrasound technique to replace CT for follow ups.

Keep all of us updated on your next step. Prayers to u and for ur family.

How often did you have to go to your follow ups?