Median Arcuate Ligament Syndrome (MALS) – Diagnosis and Treatment
Diagnosis
Doctors use several methods to figure out if someone has median arcuate ligament syndrome (MALS), also called celiac artery compression syndrome or Dunbar syndrome.
The process often starts with learning about a personโs symptoms. Common complaints include chronic abdominal pain, postprandial abdominal pain (pain after eating), nausea, vomiting, bloating, recurrent abdominal pain, weight loss, diarrhea, or other gastrointestinal symptoms.
An abdominal bruit, or whooshing sound, can sometimes be heard with a stethoscope and may suggest celiac artery stenosis due to vessel narrowing.
Since many conditions can cause similar issues, doctors try to rule out other causes first. They also look for signs of foregut ischemia, which means not enough blood is reaching the stomach and intestine.
Types of Tests Doctors Use
Below is a table showing some common tests and what they can help with:
| Test Name | What It Checks |
|---|---|
| Blood tests | Looks for problems with the liver, kidneys, and pancreas. Shows if thereโs an infection or inflammation. |
| Duplex ultrasound | Measures blood flow in vessels to check for compression of the celiac artery. |
| Upper endoscopy (EGD) | Allows doctors to see inside the stomach, esophagus, and upper intestine. Takes small tissue samples. |
| Gastric emptying study | Checks if food moves through the stomach slowly, which could be from pressure on the celiac artery. |
| MRI or magnetic resonance angiography | Makes detailed body images; shows how blood moves through the arteries using special contrast dye. |
| Abdominal CT and CT angiogram (CTA) | Creates cross-section images to show if the celiac artery is narrowed or blocked; contrast dye may help. |
| Celiac plexus block | Injects numbing medicine near the celiac artery nerves to see if symptoms improve, much like after surgery. |
Doctors use blood tests early on to check for infections or organ problems that could cause abdominal pain or related symptoms.
Doctors use an ultrasound of the abdomen to scan the celiac artery and check for compression. Deep breathing during the test can help show changes in blood flow.
An upper endoscopy (EGD) allows doctors to see if there are visible problems in the stomach or upper intestine. They can also take small samples to check for other diseases.
Gastric emptying studies help if someone has ongoing nausea and bloating. These tests show if food is leaving the stomach slower than usual.
Doctors use advanced imaging, like MRI, MRA, CT, or CTA, to create detailed pictures of the arteries and spot narrowing and blockages of the celiac artery.
When performing a celiac plexus block, doctors numb the nerves near the artery. If this relieves symptoms, it may suggest that surgery could help.
Treatment
Surgeons usually treat median arcuate ligament syndrome (MALS) with surgery as the main way to help symptoms.
Standard treatment is median arcuate ligament release. This operation removes pressure from the celiac artery and nearby nerves, which can improve blood flow and may ease pain after eating.
There are two main ways surgeons perform this surgery:
| Surgery Type | Description |
|---|---|
| Open Surgery | A single, larger cut is made in the abdominal area. |
| Laparoscopic Surgery | Several small cuts are used. Small tools and a camera help the surgeon see inside. This method is less invasive and may allow for a faster recovery. |
During the operation, the surgeon cuts away the part of the ligament causing the problem. Surgeons often remove nerves near the celiac artery as well. In some cases, they check blood flow through the celiac artery during surgery.
Surgeons may need to fix or replace the celiac artery if blood flow is not restored. The most used procedures for this are primary reanastomosis (reconnecting artery parts) or celiac artery bypass grafting (creating a new path for blood flow).
In rare cases, angioplasty or minimally invasive techniques like percutaneous transluminal angioplasty might be considered.
Most patients stay in the hospital for 2-3 days after surgery. Doctors use follow-up scans, such as an ultrasound or CT scan, to check blood flow one month later.
If weight loss happened before surgery, a nutritionist can help with restoring proper nutrition and healthy eating habits.
Everyday Habits and Care at Home
People can manage stress and pain with daily habits. They may find relief by using relaxation methods, such as deep breathing or meditation.
Simple changes, like eating smaller meals, gentle exercise, and getting enough sleep, can also support well-being and help with symptoms.
Ways to Manage and Find Support
People dealing with MALS may sometimes feel tired, weak, or emotionally drained. Joining a support group can offer encouragement and help them talk with others who understand their struggles.
Talking openly about stress and sharing coping tips can make things feel less overwhelming.
Support Tips Table
| Support Option | Benefit |
|---|---|
| Support groups | Shared experiences |
| Talking to others | Emotional relief |
It also helps to ask a healthcare provider about local groups or online communities that can help with both fatigue and emotional support.
Getting Ready for Your Medical Visit
Steps You Can Take Before the Appointment
Preparing for a medical visit helps you make the most of your time with the healthcare team. Here are tasks to consider:
- Check for special instructions. If laboratory or imaging tests are planned, you might need to avoid eating or drinking beforehand. Double-check if any specific preparation is needed.
- Make a list of all symptoms. Record any symptoms, including those that do not seem related. This can help the doctor see the full picture.
- Track personal and family health history. Write down any family conditions like heart disease, high blood pressure, stroke, or blood clotting disorders. Note any recent changes or stressful events in your life.
- Record current medications. List all prescription medicines, over-the-counter drugs, vitamins, and supplements you use. Include the amount you take and why you take each one.
- Consider your body habitus. Noting changes in weight, appetite, or physical appearance can help the doctor understand patterns that might relate to your symptoms.
- Bring someone with you. If possible, ask a family member or friend to join you. They can support you, help remember details, or ask questions you may miss.
- Write questions in advance. Preparing questions ahead of time ensures you remember to ask about your main concerns. Arrange them so the most important come first.
Example Questions to Ask:
| Key Topic | Sample Question |
|---|---|
| Symptom cause | What could be causing my stomach pain? |
| Alternatives | Are there other conditions this could be? |
| Needed tests | What types of tests will help with my diagnosis? |
| Treatment options | Which treatments are recommended? |
| Activity guidelines | What level of physical activity is safe for me? |
| Other medical conditions | How should I manage this with my other health issues? |
| Restrictions or lifestyle changes | Are there things I should avoid doing or eating? |
Add concerns about daily activities, diet, body weight changes, or how the condition may affect your regular routine as needed.
Typical Questions Your Healthcare Team May Ask
To make the appointment more productive, prepare for possible questions from the healthcare team. These may include:
- When did you first notice your stomach pain or other symptoms?
- Do your symptoms stay constant or do they come and go?
- How would you rate your pain?
- Is there anything that helps relieve your symptoms?
- Does anything make your pain worse, such as certain foods or physical activity?
- Have you begun skipping meals or activities because of discomfort?
- Has your weight changed without trying?
Prepare to answer these questions to save time and get the most out of the visit. If you have tracked changes in your body habitus, such as sudden weight loss or gain, mention this as well.
Sharing this information gives the healthcare professional a complete view of your situation and helps plan the next steps.
