Median Arcuate Ligament Syndrome – Symptoms and Causes
Overview
Median arcuate ligament syndrome (MALS) occurs when a band of tissue in the upper abdomen compresses the celiac artery. This artery supplies blood to the stomach, liver, and spleen.
The compression happens when the median arcuate ligament, which normally creates a pathway for the aorta between the chest and abdomen, is positioned abnormally.
The condition can affect anyone, including children, and often causes significant abdominal pain. MALS is also known by several other names:
- Celiac artery compression syndrome
- Celiac axis syndrome
- Dunbar syndrome
When the ligament presses on the celiac artery, it also affects the surrounding nerve network called the celiac plexus. This pressure creates the painful symptoms associated with the condition.
The problem occurs due to anatomical variations where either the ligament or the arteries are not in their typical positions.
Instead of the ligament passing over the aorta with the celiac artery sitting comfortably below, the structures overlap and cause compression.
Surgical intervention is the standard treatment approach for MALS. The procedure aims to release the pressure that the ligament places on both the artery and nerves.
Signs and Symptoms
People with MALS may experience several digestive problems. The main symptoms happen when nerves get squeezed along with the celiac artery. Not everyone with this condition will have symptoms.
Common symptoms include:
- Sharp stomach pain after eating or exercise
- Pain relief when changing position (leaning forward/backward or standing while eating)
- Anxiety about eating due to pain
- Weight loss without trying
- Feeling bloated
- Loose stools
- Feeling sick and throwing up
When To Get Medical Help
If you have ongoing stomach pain that doesn’t get better with home treatment, contact your healthcare provider. You’ll need a thorough exam to find out what’s causing your pain.
Call your doctor right away if:
- Your stomach pain is severe and gets worse with movement
- You notice blood in your stool
- You have a fever
- You experience persistent nausea and vomiting
- Your belly feels very tender when touched
- Your abdomen appears swollen
- Your skin or eye whites look yellow (jaundice)
Important warning: Upper stomach pain can sometimes be mistaken for chest pain. Call 911 immediately if you experience chest or upper stomach pain along with:
- Chest pressure, fullness or tightness
- Pain that spreads to your jaw, neck, shoulders or arms
- Pain lasting more than a few minutes or worsening with activity
- Trouble breathing
- Cold sweats
- Feeling dizzy or weak
- Nausea or vomiting
These could be signs of a heart attack requiring emergency care.
Causes
The exact reason why median arcuate ligament syndrome (MALS) occurs remains unknown. Medical experts have not yet determined what specifically triggers this condition. Research continues to investigate potential factors that might contribute to its development.
Risk Factors
MALS has several known risk factors, though the cause remains poorly understood:
- Gender: Women are more frequently affected than men.
- Age: Adults develop MALS more commonly than children.
- Genetic Factors: Cases have been documented in identical twins, suggesting possible hereditary links.
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Physical trauma: Some patients develop MALS following:
- Pancreatic surgery
- Blunt trauma to the upper abdominal region
These patterns help healthcare providers identify individuals who might be at higher risk, though more research is needed to fully understand why MALS develops in certain people.
Complications
Median arcuate ligament syndrome (MALS) can cause persistent pain. This pain is especially noticeable after eating. The ongoing discomfort may lead to food avoidance behaviors and substantial weight reduction.
People with MALS often experience:
- Chronic Abdominal Pain
- Significant Weight Loss
- Fear of Eating
- Reduced Quality of Life
The symptoms of MALS can be unclear. They may also mimic other health problems. This similarity makes diagnosis challenging.
As a result, MALS is often identified late. The continuous pain, combined with possible depression or anxiety, can significantly impact daily functioning.
