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?

@lisa01

Are you aware of a FB support group called MALS PALS. It is a support group for people suffering with MALS and their loved ones. It gives a tremendous amount of informstion of individual struggles, and various treatments and specialists that treat MALS. Highly recommended!!

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Yes, that would nice if we could cross reference MALS it affects so many areas. @malsman, how long have you been diagnosed? Have you found anything helpful? I had Open Mals Celiac bypass with ganglionectomy with my 1st surgery. My second surgery included a revision on the dacron graph and included a omental patching around the area to prevent scar tissue from reforming. It all seems like a blur to me.

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@lisa01

Are you aware of a FB support group called MALS PALS. It is a support group for people suffering with MALS and their loved ones. It gives a tremendous amount of informstion of individual struggles, and various treatments and specialists that treat MALS. Highly recommended!!

Jump to this post

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

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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/

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@kariulrich

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/

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

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@lmtuska

Hello, my 16 yr old Daughter has been diagnosed with MALS. We are coming to Mayo, MN, in February for an open surgery with a Vascular Surgeon. I, too, am interested in connecting with others to best understand this condition, follow up care and research resources. I would be interested in the webinar. Thank you Colleen!

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@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?

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@lmtuska

Hello, my 16 yr old Daughter has been diagnosed with MALS. We are coming to Mayo, MN, in February for an open surgery with a Vascular Surgeon. I, too, am interested in connecting with others to best understand this condition, follow up care and research resources. I would be interested in the webinar. Thank you Colleen!

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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!

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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

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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.

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@lisa01

Are you aware of a FB support group called MALS PALS. It is a support group for people suffering with MALS and their loved ones. It gives a tremendous amount of informstion of individual struggles, and various treatments and specialists that treat MALS. Highly recommended!!

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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!

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@lisa01

Are you aware of a FB support group called MALS PALS. It is a support group for people suffering with MALS and their loved ones. It gives a tremendous amount of informstion of individual struggles, and various treatments and specialists that treat MALS. Highly recommended!!

Jump to this post

@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?

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I have not been diagnosed with MALS as of yet though my CT scan shows narrowing of the celiac trunk.
In late October I was diagnosed with a DVT in my lower calf, a week later I was diagnosed with a PE. The following week I went in with signs of a stroke, the doctor sent me home with no testing after I told him I did not want morphine. Shortly after this I developed severe abdominal pain. The pain is chronic, though it goes from dull moderate to severe, worsened by eating, even the smallest amount. Since mid November I have lost just over 23 pounds. My questions are, has anyone else had the same kind of issues? Can a blood clot or stroke cause MALS?

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