Median Arcuate Ligament Syndrome (MALS)

    Median Arcuate Ligament Syndrome (MALS)

Rare condition characterized by abdominal pain attributed to compression of the celiac artery and the celiac ganglia by the median arcute ligament. The abdominal pain may be related to meals, may be accompanied by weight loss, and may be associated with an abdominal bruit herd by a clinician. 

  MALS  may occur in anyone, even children. other names of MALS are:

- Celiac artery compression

- Celica axis syndrome

- Dunbar syndrome

 Symptoms:

  Often, compression of the celiac artery doesn't cause any symptoms. 

 However those with median arcuate ligament syndrome(MALS) can have long-term(chronic) stomach pain. The symptoms may be due to a lack of blood flow through the celaic artery or compression on nerves in the area. 

Symptoms of MALS include: 

- Pain in the upper middle stomcah area, which may go away when leaning forward 

- Stomch pain after eating , exercising or changing body position. 

- Bloting

- Diarrhea: Diarrhea is a common symptoms, some experience constipation. While some experience vomiting, not everyone dose. Exercise or certain postures can aggravate the symptoms. Occasionlly, physical examination reveals an abdominal bruit in the mid-epigastrium. 

- Fear of eating food due to pain, leading to significant weight loss.

 

- Nausea and vomiting. 

 If your stomach pain is severe and activity or movement makes it worse, call your provider immediately. Seek immediate medical help if your stomach pain occurs with:

- Bloody stools

- Fever

- Nausea and vomiting that doesn't go away

- severe tenderness when you touch your belly area

- Swelling of the belly area

- Yellowing of the skin or whites of the eyes(Jaundice). 

 Sometimes upper stomach pain can be confused with chest pin. Sometimes it can be due to a heart attack. Upper stomach pain with or without any of the following symptoms: 

 - pressure, fullness or tightness in your chest

- Crushing or searing pain that spreads to your jaw, neck, shoulders, and one or both arms. 

- Pain that lasts more than a few minutes or gets worse with activity

- Shortness of breath

- cold sweats

- Dizziness or weakness

- Nausea or vomiting.

Risk factors:

- Because the cause of MALS is poorly understood, the risk factors for the syndrome are unclear. MALS has been seen in children, even twins, which might mean genetics plays a role. Some people have developed MALS after pancreatic surgery and blunt injury to the upper stomach area. 

Prognosis:

 

 There are few studies of the long-term outcomes of patients treated for MALS. according to Duncan, the largest and more relevant late outcomes data come from a study of 51 patients who underwent open surgical treatment for MALS, 44 of whom were available for long-term follow-up at an average of nine yers following therapy. 

- The investigators reported that among patients who underwent celiac artey decompression and revascularization, 75% remained asymptomatic at follow-up. In the study, predictors of favorable outcome included

- Age from 40 to 60 years

- Lack of psychiatric condition or alcohol use

- Abdominal pain that was worse after meals

- Weight loss greater than 20 lb. 

 Complications:

 MALS complications include long-term pain, especially after meals. The pain cn led to a fear of eating and significant weight loss. The pain and related depression or anxiety can greatly impact. 

 The pain and related depression or anxiety can greatly impact quality of life. MALS symptoms may be vague and can mimic other conditions. It may take some time to get an accurate diagnosis. 

 

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