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.

Ingegerd Enscoe, Alumni Mentor | @astaingegerdm | Dec 2, 2019

In reply to @rb4hu "@ethanmcconkey @astaingegerdm Hi there my brother has been going through severe abdominal pain for 13 months..." + (show)

@rb4hu - As far as I know an abnormal Doppler ultrasound should be confirmed with a CTA. Since my surgery and stent placement I had follow ups with CTA. However, at my last visit I was told that I can have ultrasound exams. It also depends on the institution doing the test. It is always good to get a second opinion. You would then bring the report on the Doppler and the CTA images. It is possible a vascular surgeon or GI surgeon would have more experience evaluating your brother. If possible, go to a major university medical center. I hope he will get relief soon. I know that pain.

rb4hu | @rb4hu | Dec 2, 2019

@ethanmcconkey @astaingegerdm

Hi there my brother has been going through severe abdominal pain for 13 months and he has always had digestion issues. Recently he went to the GI who thought it is gastroparesis but he has received no relief and the pain continues to increase especially when he eats or drinks. We finally found out about MALS through a gastroparesis support group. He got a doppler ultrasound and we are waiting for the report but have the images - just not sure how to read it. He ended up in the ER today and they did a CTA with contrast but they don’t see MALS. I of course want another opinion. Can the ultrasound be enough to get diagnose and be a candidate for the celiac plexus block?

Ingegerd Enscoe, Alumni Mentor | @astaingegerdm | Nov 27, 2019

@jonathand - I’m sorry to hear about your misery. Do you have pain after meals as well? I had same surgery and was fine for a few months, but then the pain returned. The celiac artery never unfolded and I got a stent to keep it open. It works well now. Nausea could have several causes including acid reflux. Check with your doctor if it could be from surgery- maybe they want to check if artery is still parent.

lasirvent | @lasirvent | Nov 25, 2019

Check on Facebook the group MALS awareness. They have a lot of useful information-sorry to hear you’re having problems.

jonathand | @jonathand | Nov 25, 2019

Hello, I had MALS surgery 3 months ago. I was doing extremely well up until 1-2 weeks ago. Nausea can be extreme at times. My question is how long is a "full" recovery of the abdomen after surgery such as this? I had my surgery done laparoscopically. My surgeon also stated that he removed a lot of scar tissue during my surgery. I am just wondering if my nerves and abdomen are still healing.

jdebusk | @jdebusk | Nov 16, 2019

In reply to @missmirandasue5 "Hello I have been following the group for a while and reading the feed. I was..." + (show)

@missmirandasue5

Hello I have been following the group for a while and reading the feed. I was diagnosed with MALS about 5 months ago. I have 2 arteries that first were shown compressed by a ligament in an ultrasound and than again in a CT. I have been very sick on and off since my teen years. Through all the illness, the severe stomach pain, the weight loss, the vomiting the diarrhea the multiple visits every year to the ER and several admits as well as exploratory surgeries which one ended up with my gallbladder removed, and still nothing. Until I went to Mayo clinic about 6 months ago and started to doctor for these symptoms that had suddenly persistently gotten the worst they had ever been. I underwent many many tests and saw several doctors. Than a doctor who had heard of MALS did some testing for this and called me the same evening at home after I had my tests and told me I should see cardiovascular. I have since underwent many pre-op clearance testing with GI, Cardiology and Internal Med. I also did a block to see if that would give me relief, in which it did, but sadly for only 3 days. It was 3 very happy and comfortable days! I am now waiting to see Cardiology again in hopes to be scheduled for surgery soon. Years of the pain, and suffering to hopefully have relief finally. On a side note, ten years ago I was diagnosed as a type one diabetic. I was diagnosed at another facility and doctored with them over the last several years. They told me my pancreas was dead and I would be a lifer as the rest of most TI diabetics. Since being a Mayo patient and seeing Endocrinology, I have learned that my pancreas is still working about 20% and they blood flow that has been cut off by the ligament from my arteries is most likely a sure cause that my pancreas has almost died and has given me the life of a diabetic. It is hard some days to know that other doctors could have caught all this, saved my pancreas so many years ago and I would be diabetes free. I am hopeful the blood flow that will be re- entered into my body once I have the MALS surgery will bring my pancreas back to life, but the doctors are only giving it a low chance of this happening. It is a harsh reality to swallow. This is my story and I wanted to share. I am nervous about having the surgery, as we have decided open is the best option. I will be so happy to eat and not have the pain any more.

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I am following in your path..I am scheduled for the celiac plexus block on 11/26 and hope to feel some relief too. If positive, I can plan for MALS surgery. Will you use Dr. Bowers? He is the one who I am being guided to. Thanks

Ingegerd Enscoe, Alumni Mentor | @astaingegerdm | Nov 13, 2019

In reply to @tutorgrl "I had lap surgery 4 weeks ago along with unroofing of the nerves of the celiac..." + (show)

@tutorgrl - Hi! I know it’s discouraging if the symptoms returned so soon after surgery. Have you talked to the surgeon about this? There could be a couple of causes, such as post op swelling in the area putting pressure on the artery, or if the artery was kinked because of the ligament’s pressure and has not opened up. That happened to me after 4-5 months. A stent was placed and it has been fine for 4 years so far.
Definitely let the surgeon know.

jdebusk | @jdebusk | Nov 13, 2019

In reply to @jmacbain "There's a doctor in CT Dr Hsu that's very familiar with MALS. There's also some in..." + (show)

Which surgeons are you referring to in FL that have experience with MALS?

jmacbain | @jmacbain | Nov 13, 2019

Nice try

jdebusk | @jdebusk | Nov 13, 2019

In reply to @sclindajanssen "I had MALs lap surgery at Mayo 1 year ago. I’m doing great now. About 15..." + (show)

HI. Who did your surgery at Mayo? Was it Dr. Bowers? I am waiting for a celiac nerve block to be scheduled then, if it relieves the pain and symptoms, I can get an appointment with the Dr.

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