Materiały źródłowe

• #1 MALS (Median Arcuate Ligament Syndrome): Symptoms & Diagnosis

  https://my.clevelandclinic.org/health/diseases/16635-median-arcuate-ligament-syndrome-mals

  Median arcuate ligament syndrome (MALS) is a very rare disease in which the median arcuate ligament presses on your celiac artery and nearby nerves (celiac plexus). Treatment is surgery to separate the ligament from the celiac artery and celiac plexus. […] MALS is an unusual disease that causes physical and mental health issues. So, you can expect to have a whole team of specialists working to help you find relief, including gastroenterologists, general surgeons, vascular surgeons, pain management specialists, psychologists, and dietitians. […] Your healthcare provider may recommend a celiac plexus block to help ease stomach pain. They may recommend median arcuate ligament release, which is surgery to remove or release your ligament so it’s not pressing on your celiac artery. This procedure restores blood flow through your celiac artery and removes pressure on nearby nerves. […] MALS symptoms can come back after surgery. You should contact your care team if that happens.

• #2 Median arcuate ligament syndrome – UpToDate

  https://www.uptodate.com/contents/celiac-artery-compression-syndrome

  Median arcuate ligament syndrome (MALS) is defined as chronic, recurrent abdominal pain related to compression of the celiac artery by the median arcuate ligament. […] Treatment involves surgical decompression of the celiac axis. Treatment success, which cannot be guaranteed, depends upon appropriate patient selection. […] Celiac artery decompression can be accomplished using an open or minimally invasive approach, which can either be a standard laparoscopic or a robotic-assisted approach. […] For some patients, celiac artery revascularization (open, endovascular) may be necessary. […] The etiology, clinical features, diagnosis, and treatment of MALS are reviewed here. […] The syndrome is also referred to as celiac artery compression, celiac artery compression syndrome, celiac axis syndrome, and Dunbar syndrome. […] Compression of the celiac artery by the median arcuate ligament is accentuated during expiration as the median arcuate ligament moves cranially and relieved during inspiration.

• #3 Median Arcuate Ligament Syndrome (MALS) | University Hospitals | University Hospitals

  https://www.uhhospitals.org/services/heart-and-vascular-services/conditions-and-treatments/vascular-disease/median-arcuate-ligament-syndrome

  Median arcuate ligament syndrome (MALS) is a condition in which a ligament in the lower part of the chest, the median arcuate ligament, sits lower than normal. As a result, it presses against the celiac artery (the main blood vessel that supplies blood to the stomach, liver and other organs) and other nerves in the surrounding area (celiac plexus). […] University Hospitals Harrington Heart Vascular Institute is recognized across the country as leader in advanced minimally invasive and surgical techniques, achieving remarkable patient outcomes. In the area of MALS care, for more than 20 years, vascular surgeon Dr. W. Michael Park has played a key role nationally in improving the diagnosis and treatment of MALS, as well as becoming a devoted MALS patient advocate. […] MALS reduces blood flow to the stomach, liver and other organs, which can result in pain in the upper part of the belly. The symptoms of MALS are often similar to appendicitis, stomachache, irritable bowel syndrome (IBS) and other stomach problems.

• #4 Median Arcuate Ligament Syndrome | Top Diagnosis & MALS Surgery Near You – The Vascular Experts

  https://thevascularexperts.com/median-arcuate-ligament-syndrome/

  MALS is a congenital anatomic anomaly, meaning it is a structural aberrance present at the time of birth. […] Patients are often unable to eat due to pain/nausea and many lose weight. […] Because MALS patients present with gastrointestinal symptoms, they often go through a battery of GI tests, including EGDs, gastric emptying tests, and colonoscopies. […] The anatomy for MALS can be seen on an abdominal CT scan. […] Other diagnostic criteria required for diagnosis include physical exam findings consistent with inflamed celiac ganglion, and celiac ganglion block to rule in neurogenic cause of pain. […] Those who believe MALS is a neurologic issue focus on the celiac ganglion as the main cause of a patients symptoms. […] These inflamed nerves must be addressed to resolve the patients disabling pain.

• #5 Median arcuate ligament syndrome – UpToDate

  https://www.uptodate.com/contents/celiac-artery-compression-syndrome

  Median arcuate ligament syndrome (MALS) is defined as chronic, recurrent abdominal pain related to compression of the celiac artery by the median arcuate ligament. […] Treatment involves surgical decompression of the celiac axis. Treatment success, which cannot be guaranteed, depends upon appropriate patient selection. […] Celiac artery decompression can be accomplished using an open or minimally invasive approach, which can either be a standard laparoscopic or a robotic-assisted approach. […] For some patients, celiac artery revascularization (open, endovascular) may be necessary. […] The etiology, clinical features, diagnosis, and treatment of MALS are reviewed here. […] The syndrome is also referred to as celiac artery compression, celiac artery compression syndrome, celiac axis syndrome, and Dunbar syndrome. […] Compression of the celiac artery by the median arcuate ligament is accentuated during expiration as the median arcuate ligament moves cranially and relieved during inspiration.

• #6 Median Arcuate Ligament Syndrome: Where Are We Today? – PubMed

  https://pubmed.ncbi.nlm.nih.gov/39418076/

  Median arcuate ligament syndrome, or celiac artery compression syndrome (eponym: Dunbar syndrome), has historically been attributed to pathophysiologic vascular compression causing downstream ischemic symptoms of the organs supplied by the celiac trunk. […] However, the more we learn about the histology, clinical presentation, and treatment outcomes, health care providers are increasingly correlating the symptoms of MALS with the long-term, repetitive compression of the celiac ganglion rather than the celiac trunk. This article provides a comprehensive review of current MALS literature, emphasizing the multidisciplinary approach these patients require in all phases of their care. […] With most patients with MALS waiting an average of 10.5 months to 2.6 years, our need for better diagnostic protocols and clearer understanding of the pathophysiology of the disease is paramount. Further investigation into patient outcomes, associated conditions, and linked pathophysiology would help better characterize this disease with hopes of moving it from a diagnosis of exclusion to one of standard work-up with decreased time to treatment and symptom relief for patients.

• #7 Median Arcuate Ligament Syndrome: Management and Literature Review

  https://pmc.ncbi.nlm.nih.gov/articles/PMC9542491/

  Pain, nausea, vomiting, weight loss, diarrhea, and fatigue are common symptoms of several upper gastroenterological illnesses. However, the presence of unexplained recurring postprandial abdominal pain and vomiting increases the possibility of median arcuate ligament syndrome (MALS). MALS is an uncommon illness characterized by postprandial vomiting, abdominal pain, and weight loss. […] Accurate diagnosis is key to reducing time and resources, establishing a cure, and restoring a patients quality of life. […] Therefore, it is essential to consider MALS when evaluating a patient with these upper gastroenterological symptoms. […] Surgery has consistently been reported as a potential management option. If not diagnosed and managed appropriately, common complications such as electrolyte imbalance and its manifestation, prodromes of malnutrition, and possible psychosomatic disorders such as anxiety may arise.

• #8 Median arcuate ligament syndrome: When to consider the diagnosis and management options

  https://www1.racgp.org.au/ajgp/2024/supplement-december/median-arcuate-ligament-syndrome

  Median arcuate ligament syndrome (MALS) occurs due to extrinsic compression of the coeliac plexus, leading to postprandial and exercise-induced epigastric pain, nausea, vomiting, food fear and weight loss. […] Primary care physicians are commonly the first people to encounter patients with MALS and play a vital role in its assessment, diagnosis and management and the coordination of subspecialty care. […] The primary presenting symptom of MALS is abdominal pain. Determining a diagnosis for chronic abdominal pain can be challenging due to the broad differentials and extensive work-up required, along with the significant effects on the patients quality of life. […] MALS occurs most commonly in young women. They describe abdominal pain, weight loss, bloating, nausea and vomiting, which can be related to eating and drinking or be exercise induced.

• #9 Median Arcuate Ligament Syndrome Clinical Presentation, Pathophysiology, and Management: Description of Four Cases

  https://www.mdpi.com/2624-5647/3/1/5

  Median arcuate ligament syndrome (MALS), otherwise called celiac artery compression syndrome (CACS), is an uncommon disorder that results from an anatomical compression of the celiac axis and/or celiac ganglion by the MAL. Patients typically present with abdominal pain of unknown etiology exacerbated by eating along with nausea, vomiting, and weight loss. MALS is a diagnosis of exclusion that should be considered in patients with severe upper abdominal pain, which does not correlate with the objective findings. The definitive treatment is the median arcuate ligament’s surgical release to achieve surgical decompression of the celiac plexus by division of the MAL. […] The typical symptom in MALS is chronic epigastric pain aggravated by meals. Other symptoms include nausea, vomiting, and accompanying weight loss.

• #10 MALS: Causes, Symptoms & Treatment | Dr. Joshua Tierney

  https://www.drjoshuatierney.com/conditions/vascular/mals/

  Median Arcuate Ligament Syndrome (MALS) is a rare but potentially debilitating condition caused by the compression of the celiac artery by the median arcuate ligament. This anatomical abnormality can restrict blood flow through the celiac artery to major abdominal organs, leading to symptoms that are often mistaken for other gastrointestinal disorders. Patients with MALS commonly experience epigastric pain, chronic abdominal pain, nausea, vomiting, and unintentional weight loss. […] Effective management of MALS often involves a team of specialists, including gastroenterologists, vascular surgeons, and pain management experts, working together to provide comprehensive and personalized care. This collaborative approach is critical for the management of median arcuate ligament syndrome and the surgical treatment of MALS.

• #11 Median arcuate ligament syndrome: When to consider the diagnosis and management options

  https://www1.racgp.org.au/ajgp/2024/supplement-december/median-arcuate-ligament-syndrome

  Median arcuate ligament syndrome (MALS) occurs due to extrinsic compression of the coeliac plexus, leading to postprandial and exercise-induced epigastric pain, nausea, vomiting, food fear and weight loss. […] Primary care physicians are commonly the first people to encounter patients with MALS and play a vital role in its assessment, diagnosis and management and the coordination of subspecialty care. […] The primary presenting symptom of MALS is abdominal pain. Determining a diagnosis for chronic abdominal pain can be challenging due to the broad differentials and extensive work-up required, along with the significant effects on the patients quality of life. […] MALS occurs most commonly in young women. They describe abdominal pain, weight loss, bloating, nausea and vomiting, which can be related to eating and drinking or be exercise induced.

• #12 Median Arcuate Ligament Syndrome (MALS): An In-depth Analysis – Longmore Clinic

  https://longmoreclinic.org/median-arcuate-ligament-syndrome-mals-an-in-depth-analysis/

  Median Arcuate Ligament Syndrome (MALS), also known as celiac artery compression syndrome, is a rare vascular condition that can cause severe abdominal pain. It occurs when the median arcuate ligament, a fibrous band of tissue in the diaphragm, compresses the celiac artery, the primary blood supply to the upper abdominal organs. This compression can lead to various symptoms and impact an individuals daily life. […] The most common symptom of MALS is abdominal pain, which can range from mild to severe. It typically occurs after eating, as blood flow to the digestive organs increases. The pain is usually located in the upper abdomen, just below the ribcage, and may be accompanied by other symptoms, including: Nausea and vomiting, Unintended weight loss, Bloating or fullness after eating, Diarrhea or constipation.

• #13 Median Arcuate Ligament Syndrome: Management and Literature Review

  https://pmc.ncbi.nlm.nih.gov/articles/PMC9542491/

  Pain, nausea, vomiting, weight loss, diarrhea, and fatigue are common symptoms of several upper gastroenterological illnesses. However, the presence of unexplained recurring postprandial abdominal pain and vomiting increases the possibility of median arcuate ligament syndrome (MALS). MALS is an uncommon illness characterized by postprandial vomiting, abdominal pain, and weight loss. […] Accurate diagnosis is key to reducing time and resources, establishing a cure, and restoring a patients quality of life. […] Therefore, it is essential to consider MALS when evaluating a patient with these upper gastroenterological symptoms. […] Surgery has consistently been reported as a potential management option. If not diagnosed and managed appropriately, common complications such as electrolyte imbalance and its manifestation, prodromes of malnutrition, and possible psychosomatic disorders such as anxiety may arise.

• #14 Median arcuate ligament syndrome: When to consider the diagnosis and management options

  https://www1.racgp.org.au/ajgp/2024/supplement-december/median-arcuate-ligament-syndrome

  Median arcuate ligament syndrome (MALS) occurs due to extrinsic compression of the coeliac plexus, leading to postprandial and exercise-induced epigastric pain, nausea, vomiting, food fear and weight loss. […] Primary care physicians are commonly the first people to encounter patients with MALS and play a vital role in its assessment, diagnosis and management and the coordination of subspecialty care. […] The primary presenting symptom of MALS is abdominal pain. Determining a diagnosis for chronic abdominal pain can be challenging due to the broad differentials and extensive work-up required, along with the significant effects on the patients quality of life. […] MALS occurs most commonly in young women. They describe abdominal pain, weight loss, bloating, nausea and vomiting, which can be related to eating and drinking or be exercise induced.

• #15 Median Arcuate Ligament Syndrome – Florida Surgical Clinic

  https://floridasurgicalclinic.com/posts/median-arcuate-ligament-syndrome/

  Median arcuate ligament syndrome occurs when the celiac artery is kinked or compressed by the median arcuate ligament which is part of the muscles of the diaphragm. […] Patients with median arcuate ligament syndrome are often young and usually female. They have difficulty eating, abdominal pain after eating, will often vomit very shortly after eating. These patients can develop a progressive aversion to food and weightloss. […] Median arcuate ligament syndrome is a diagnosis of exclusion. That means that prior to making this diagnosis a patient should be thoroughly examined for more common ailments such as gallbladder disease or gastroesophageal reflux disease. Once common things are ruled out and if the ultrasound or other diagnostic tests are consistent with the syndrome surgery to divide the median arcuate ligament and nerves surrounding the celiac artery is performed. This surgery can be done laparoscopically or in an open fashion. […] Median arcuate ligament syndrome is a serious health issue that requires the attention of a board-certified vascular surgeon.

• #16 Median arcuate ligament syndrome: Incidental finding or real problem? | Cleveland Clinic Journal of Medicine

  https://www.ccjm.org/content/88/3/140

  The median arcuate ligament is a fibrous arch connecting the crura of the diaphragm forming the aortic hiatus and lying superior to the celiac artery. MALS, also known as Dunbar syndrome or celiac artery compression syndrome, is a rare phenomenon caused by extrinsic compression of the celiac trunk by the median arcuate ligament. […] MALS is considered a diagnosis of exclusion, and it can coexist with other intra-abdominal pathologies and be a confounding factor. […] To enhance the benefit of surgical intervention, studies aimed at improving the ability to reliably diagnose MALS are required. Surgery should be reserved for patients who would benefit from it, and patient selection continues to be challenging, as there is relatively poor correlation between the radiographic findings of celiac artery compression and the presence or severity of symptoms. It is generally accepted that asymptomatic or incidentally discovered MALS does not warrant intervention.

• #17 A case report on median arcuate ligament syndrome: Need for a high index of suspicion – Medicine India

  https://medindiajournal.com/a-case-report-on-median-arcuate-ligament-syndrome-need-for-a-high-index-of-suspicion/

  The Median Arcuate Ligament Syndrome (MALS) is a rare clinical entity occurring due to abnormally low insertion of the ligament across the origin of the coeliac axis resulting in varying degrees of celiac artery compression. […] MALS should be considered as an important differential in patients with symptoms resembling post-prandial angina. A combination of a high index of suspicion with the use of appropriate imaging techniques can clinch this diagnosis. […] This case illustrates the classic clinical and imaging findings of this condition with an emphasis on the need for a high index of suspicion. […] The workup should exclude hepatobiliary pathology and gastric or duodenal ulcer disease because MALS is a diagnosis of exclusion. […] Ultrasound along with color and spectral Doppler imaging has emerged as a non-invasive, real-time, and dynamic screening tool that can increase diagnostic confidence. […] Surgical median arcuate ligament release has been the mainstay of treatment. […] This case confirms that MALS is a challenging diagnosis. Patients usually undergo extensive workup for their abdominal pain before this diagnosis is reached.

• #18 Median arcuate ligament syndrome: When to consider the diagnosis and management options

  https://www1.racgp.org.au/ajgp/2024/supplement-december/median-arcuate-ligament-syndrome

  MALS does not have universally accepted diagnostic criteria. […] However, it is a diagnosis that remains one of relative exclusion and is typically the result of extensive investigations to exclude more common, alternative causes of abdominal pain. […] Recommended work-up includes targeted blood tests (full blood count and liver function, renal function and lipase/amylase tests), urinary culture, biliary ultrasound, and upper and lower endoscopies with Helicobacter pylori testing and food allergy testing, including coeliac disease. […] If the above investigations are normal, along with a finding of coeliac artery compression, a diagnosis of MALS should be considered and the patient would benefit from multidisciplinary input, including from a gastroenterologist and a vascular surgeon.

• #19 Caring for kids with MALS: It’s not all in their head – UChicago Medicine

  https://www.uchicagomedicine.org/forefront/pediatrics-articles/2024/january/mals-not-all-in-their-head

  The medical journey of children with median arcuate ligament syndrome (MALS) is a long and arduous one, replete with exhaustive medical tests, misdiagnoses, and multiple encounters with pediatricians and subspecialists who often attribute a youngsters chronic abdominal pain to stress or depression. […] Comer Childrens Hospital has one of the few multidisciplinary teams in the country specializing in diagnosing and treating MALS, a vascular compression syndrome that occurs when the celiac artery is compressed by the median arcuate ligament. […] At Comer Childrens, the MALS team evaluates children for potential surgery. MALS is a diagnosis of exclusion, so patients first undergo a multipart diagnostic process involving radiologic studies and an extensive gastrointestinal workup, including duplex ultrasound and computed tomography angiogram to rule out other causes of chronic abdominal pain.

• #20 A case report on median arcuate ligament syndrome: Need for a high index of suspicion – Medicine India

  https://medindiajournal.com/a-case-report-on-median-arcuate-ligament-syndrome-need-for-a-high-index-of-suspicion/

  The Median Arcuate Ligament Syndrome (MALS) is a rare clinical entity occurring due to abnormally low insertion of the ligament across the origin of the coeliac axis resulting in varying degrees of celiac artery compression. […] MALS should be considered as an important differential in patients with symptoms resembling post-prandial angina. A combination of a high index of suspicion with the use of appropriate imaging techniques can clinch this diagnosis. […] This case illustrates the classic clinical and imaging findings of this condition with an emphasis on the need for a high index of suspicion. […] The workup should exclude hepatobiliary pathology and gastric or duodenal ulcer disease because MALS is a diagnosis of exclusion. […] Ultrasound along with color and spectral Doppler imaging has emerged as a non-invasive, real-time, and dynamic screening tool that can increase diagnostic confidence. […] Surgical median arcuate ligament release has been the mainstay of treatment. […] This case confirms that MALS is a challenging diagnosis. Patients usually undergo extensive workup for their abdominal pain before this diagnosis is reached.

• #21 Clinically Significant Progression of Median Arcuate Ligament Syndrome – Madigan | Wake Forest University School of Medicine

  https://school.wakehealth.edu/about-the-school/wake-forest-journal-of-science-and-medicine/summer-2021/clinically-significant-progression-of-median-arcuate-ligament-syndrome

  Median arcuate ligament syndrome (MALS) is a poorly understood condition characterized by compression of the celiac artery by a fibrous ligament connecting the diaphragmatic crura. […] Given the severity of her debility, the patient was medically optimized before scheduled surgery for the treatment of her suspected MALS. […] In coordination with the care team, the patient had continual supplementation for her numerous vitamin and mineral deficiencies, including total parenteral nutrition to optimize the patient before later surgical intervention for the treatment of MALS. […] Recognition of MALS as a potential etiology in the diagnostic evaluation of abdominal pain is of growing clinical importance. […] Doppler vascular ultrasound to evaluate respiratory variation can help determine if compression is clinically significant and may be contributing to abdominal pain.

• #22 Median arcuate ligament syndrome: When to consider the diagnosis and management options

  https://www1.racgp.org.au/ajgp/2024/supplement-december/median-arcuate-ligament-syndrome

  If appropriate, intervention for MALS requires a multidisciplinary approach, including vascular surgery, general surgery, pain specialists and interventional radiology. […] Coeliac plexus block is a non-surgical option for relief from MALS that can also aide as a diagnostic test. […] The surgical treatment of MALS includes decompressing the artery and performing a coeliac ganglionectomy. […] On reviewing the literature, we have proposed a diagnostic and treatment pathway. […] Due to the challenges in both diagnosis and treatment of MALS, multidisciplinary care involving general practitioners along with subspecialists is vital for successful outcomes. […] Those with MALS who have appropriate work-up, diagnosis and management have been found to have good outcomes in case series.

• #23 Median Arcuate Ligament Syndrome in 17-year-old Male with Abdominal Pain: Case Report – The Western Journal of Emergency Medicine

  https://westjem.com/articles/median-arcuate-ligament-syndrome-in-17-year-old-male-with-abdominal-pain-case-report.html

  Median arcuate ligament syndrome (MALS) is an uncommon cause of chronic abdominal pain resulting from the compression of the celiac artery. It shares symptoms with chronic functional abdominal pain, a more common cause of pediatric chronic abdominal pain. Typically found in middle-aged females, MALS is a diagnosis of exclusion. […] Median arcuate ligament syndrome is an uncommon cause of chronic abdominal pain that is difficult to differentiate from other causes, especially in pediatric patients. It should be considered in the patient whose previous workup was not conclusive and symptom management had failed. Management is multidisciplinary with non-operative management preferred initially. If there is no improvement, surgical management should be considered. […] The management of MALS varies due to the multifaceted nature of its etiology. Treatment strategies aim to alleviate the vascular or neuropathic sources of pain. In this case, the patient and his family decided to pursue non-surgical management through celiac plexus block. Other non-operative approaches include a multidisciplinary approach involving general surgery, vascular surgery, and psychiatry.

• #24 Median arcuate ligament syndrome (MALS) – Diagnosis and treatment – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/median-arcuate-ligament-syndrome-mals/diagnosis-treatment/drc-20505007

  Our caring team of Mayo Clinic experts can help you with your median arcuate ligament syndrome (mals)-related health concerns […] Surgery is the only treatment for median arcuate ligament syndrome, also called MALS. Surgery for MALS can improve or reduce symptoms in most people. […] If you have MALS release surgery, you usually stay in the hospital for 2 to 3 days. You may have an ultrasound or a CT scan about a month after surgery to make sure that blood flow is fully restored. You may need to see a nutritionist to help with returning to a healthy diet. This is particularly helpful if you have not been eating or have lost a lot of weight. […] Median arcuate ligament syndrome (MALS) care at Mayo Clinic

• #25 Median arcuate ligament syndrome (MALS)

  https://www.mymlc.com/health-information/diseases-and-conditions/m/median-arcuate-ligament-syndrome-mals/

  Median arcuate ligament syndrome (MALS) occurs when the arc-shaped band of tissue in the chest area (median arcuate ligament) presses on, or traps, the artery that supplies blood to the organs in your upper abdomen (celiac artery). […] Treatment involves surgery to release (decompress) the ligament and restore blood flow through the artery. […] Surgery is the only treatment option for MALS. The most common procedure is called median arcuate ligament release, or median arcuate ligament decompression. It’s usually done as an open surgery but sometimes can be done as a minimally invasive (laparoscopic or robotic) procedure. […] If you have MALS release surgery, you’ll usually stay in the hospital for two to three days. You’ll need an ultrasound about a month after surgery to confirm that blood flow through the celiac artery is fully restored. Several studies have shown that surgery to release the median arcuate ligament is safe, even in children with MALS. It often results in immediate pain relief and improves the person’s quality of life.

• #26 Median Arcuate Ligament Syndrome (MALS) | University Hospitals | University Hospitals

  https://www.uhhospitals.org/services/heart-and-vascular-services/conditions-and-treatments/vascular-disease/median-arcuate-ligament-syndrome

  Presently, the only treatment option for MALS is surgery. The most common such procedure is called a median arcuate ligament release, or median arcuate ligament decompression, which is done to reduce painful compression of the median arcuate ligament on the celiac artery. This surgery is increasingly performed as a minimally invasive (laparoscopic or robotic) procedure but is also done as traditional open surgery. […] Most patients who get laparoscopic surgery for MALS stay one night in the hospital and are able to resume a normal diet the following morning. Patients receive medication to relieve any pain or discomfort caused by the incisions. […] Most people who have surgery for MALS will have a duplex ultrasound a month after their procedure to check to see that there is no further compression of the median arcuate ligament.

• #27 UT Physicians | Median arcuate ligament syndrome (MALS)

  https://www.utphysicians.com/median-arcuate-ligament-syndrome/

  The standard treatment of MALS is the release of the celiac artery by open surgical or laparoscopic removal of portions of the median arcuate ligament and ganglionic tissue that surround or completely encase the celiac artery. […] Surgical treatment is aimed to reduce or eliminate pain and improve the quality of life for the patient. […] Open surgical release of the median arcuate ligament is most often done using an incision in the epigastric area. […] The main advantages of the open surgical approach rely on the safety of surgical dissection under direct vision and ability to handle any small tear or areas of bleeding. […] The main disadvantage is the need for the incision and larger exposure. […] Laparoscopic release of the celiac artery requires small holes to introduce the camera and surgical instruments without the larger incision.

• #28 Median arcuate ligament syndrome – UpToDate

  https://www.uptodate.com/contents/celiac-artery-compression-syndrome

  Median arcuate ligament syndrome (MALS) is defined as chronic, recurrent abdominal pain related to compression of the celiac artery by the median arcuate ligament. […] Treatment involves surgical decompression of the celiac axis. Treatment success, which cannot be guaranteed, depends upon appropriate patient selection. […] Celiac artery decompression can be accomplished using an open or minimally invasive approach, which can either be a standard laparoscopic or a robotic-assisted approach. […] For some patients, celiac artery revascularization (open, endovascular) may be necessary. […] The etiology, clinical features, diagnosis, and treatment of MALS are reviewed here. […] The syndrome is also referred to as celiac artery compression, celiac artery compression syndrome, celiac axis syndrome, and Dunbar syndrome. […] Compression of the celiac artery by the median arcuate ligament is accentuated during expiration as the median arcuate ligament moves cranially and relieved during inspiration.

• #29 UT Physicians | Median arcuate ligament syndrome (MALS)

  https://www.utphysicians.com/median-arcuate-ligament-syndrome/

  The standard treatment of MALS is the release of the celiac artery by open surgical or laparoscopic removal of portions of the median arcuate ligament and ganglionic tissue that surround or completely encase the celiac artery. […] Surgical treatment is aimed to reduce or eliminate pain and improve the quality of life for the patient. […] Open surgical release of the median arcuate ligament is most often done using an incision in the epigastric area. […] The main advantages of the open surgical approach rely on the safety of surgical dissection under direct vision and ability to handle any small tear or areas of bleeding. […] The main disadvantage is the need for the incision and larger exposure. […] Laparoscopic release of the celiac artery requires small holes to introduce the camera and surgical instruments without the larger incision.

• #30 UT Physicians | Median arcuate ligament syndrome (MALS)

  https://www.utphysicians.com/median-arcuate-ligament-syndrome/

  The standard treatment of MALS is the release of the celiac artery by open surgical or laparoscopic removal of portions of the median arcuate ligament and ganglionic tissue that surround or completely encase the celiac artery. […] Surgical treatment is aimed to reduce or eliminate pain and improve the quality of life for the patient. […] Open surgical release of the median arcuate ligament is most often done using an incision in the epigastric area. […] The main advantages of the open surgical approach rely on the safety of surgical dissection under direct vision and ability to handle any small tear or areas of bleeding. […] The main disadvantage is the need for the incision and larger exposure. […] Laparoscopic release of the celiac artery requires small holes to introduce the camera and surgical instruments without the larger incision.

• #31

  https://journals.lww.com/jmas/fulltext/2024/20030/performing_median_arcuate_ligament_release_surgery.12.aspx

  Median arcuate ligament syndrome (MALS), also known as Dunbar syndrome or celiac artery (CA) compression syndrome, is a rare condition characterized by persistent post-meal or post-exercise abdominal discomfort, often more pronounced during expiration. Additional symptoms include nausea, vomiting, and weight loss. […] Surgical release of the MAL is the primary treatment for MALS, providing relief for many patients. However, long-term follow-up is essential as some patients may continue to experience symptoms post-surgery, necessitating further interventions. […] The definitive treatment for MALS involves surgically releasing the MAL to alleviate compression on the celiac plexus. […] The laparoscopic technique for MAL release has shown significant benefits, including improved visualisation of the CA, reduced morbidity and shorter post-operative hospital stays. In addition to open surgical procedures, both laparoscopic and endovascular techniques have gained traction over the past decade. Ultimately, long-term follow-up is crucial to ensure that patients remain symptom-free, confirming the surgery’s effectiveness and the diagnosis’s accuracy. […] Available evidence suggests that various treatment approaches, including laparoscopic and open ligament release and CA revascularisation (using both open and endovascular methods), can offer lasting relief from symptoms in most MALS-diagnosed patients.

• #32 How Do You Fix Median Arcuate Ligament Syndrome (MALS)?

  https://www.laparoscopicsurgeons.com/blog/how-do-you-fix-median-arcuate-ligament-syndrome-mals.html

  Median Arcuate Ligament Syndrome (MALS) is a rare condition in which the median arcuate ligament, a band of tissue in the diaphragm, compresses the celiac artery a major blood vessel that supplies oxygenated blood to the upper abdominal organs. This compression leads to restricted blood flow, causing pain, discomfort, and a variety of digestive symptoms. […] The only effective way to fix MALS is through surgery. The goal of the surgery is to release the compression on the celiac artery by cutting or removing the median arcuate ligament. […] Laparoscopic surgery offers a highly effective way to treat MALS while minimizing the impact on the patient’s body. […] Robotic surgery is increasingly being adopted for MALS treatment because of these advantages, especially in complex cases where precision is paramount.

• #33 Median arcuate ligament syndrome (MALS) // Middlesex Health

  https://middlesexhealth.org/learning-center/diseases-and-conditions/median-arcuate-ligament-syndrome-mals

  Surgery is the only treatment for median arcuate ligament syndrome, also called MALS. Surgery for MALS can improve or reduce symptoms in most people. […] During decompression surgery, the surgeon cuts away parts of the median arcuate ligament. This reduces pressure on the celiac artery and nerves. The surgeon removes the nerves around the celiac artery and its branches. […] If you have MALS release surgery, you usually stay in the hospital for 2 to 3 days. You may need to see a nutritionist to help with returning to a healthy diet. This is particularly helpful if you have not been eating or have lost a lot of weight.

• #34 Median Arcuate Ligament Syndrome Clinical Presentation, Pathophysiology, and Management: Description of Four Cases

  https://www.mdpi.com/2624-5647/3/1/5

  The definitive treatment is the surgical release of the median arcuate ligament to achieve decompression of the celiac plexus. […] Surgery is the definitive treatment to divide the median arcuate ligament to decompress the celiac artery and celiac plexus. […] The surgical approach of minimally invasive laparoscopic and robotic techniques focuses on ligating the ligament, and often times results in partial surgical disruption of the celiac plexus, thus overcoming the compression of the celiac ganglion from which the symptoms are emanating. Finally, it is important for the long-term follow-up of these patients to make sure that they are symptom-free, thus confirming the sustainability of the surgery and the accuracy of the diagnosis.

• #35 UT Physicians | Median arcuate ligament syndrome (MALS)

  https://www.utphysicians.com/median-arcuate-ligament-syndrome/

  Endovascular approach is not recommended as a stand-alone therapy because the muscle and ligament cause persistent compression of the artery, which typically recoils back to its compressed state after the balloon angioplasty. […] Most studies evaluating the outcomes of MALS are retrospective reviews of single center experiences spanning many years and having a relatively small number of patients. […] Living with any chronic illness can be challenging and frustrating for patients and their loved ones.

• #36 Median arcuate ligament syndrome – UpToDate

  https://www.uptodate.com/contents/celiac-artery-compression-syndrome

  Median arcuate ligament syndrome (MALS) is defined as chronic, recurrent abdominal pain related to compression of the celiac artery by the median arcuate ligament. […] Treatment involves surgical decompression of the celiac axis. Treatment success, which cannot be guaranteed, depends upon appropriate patient selection. […] Celiac artery decompression can be accomplished using an open or minimally invasive approach, which can either be a standard laparoscopic or a robotic-assisted approach. […] For some patients, celiac artery revascularization (open, endovascular) may be necessary. […] The etiology, clinical features, diagnosis, and treatment of MALS are reviewed here. […] The syndrome is also referred to as celiac artery compression, celiac artery compression syndrome, celiac axis syndrome, and Dunbar syndrome. […] Compression of the celiac artery by the median arcuate ligament is accentuated during expiration as the median arcuate ligament moves cranially and relieved during inspiration.

• #37 Median arcuate ligament syndrome (Dunbar syndrome) – Iqbal – Cardiovascular Diagnosis and Therapy

  https://cdt.amegroups.org/article/view/67298/html

  There is role of PTA in post-surgical recurrence. PTA is useful as an adjuvant in the patients with residual symptoms after surgery with addition of balloon expandable stents. […] The treatment is aimed at relieving the symptoms with open or laparoscopic surgery with PTA and stenting as adjuvant to robotic ligament release and celiac neurolysis.

• #38 Median arcuate ligament syndrome (MALS) – Diagnosis and treatment – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/median-arcuate-ligament-syndrome-mals/diagnosis-treatment/drc-20505007

  Our caring team of Mayo Clinic experts can help you with your median arcuate ligament syndrome (mals)-related health concerns […] Surgery is the only treatment for median arcuate ligament syndrome, also called MALS. Surgery for MALS can improve or reduce symptoms in most people. […] If you have MALS release surgery, you usually stay in the hospital for 2 to 3 days. You may have an ultrasound or a CT scan about a month after surgery to make sure that blood flow is fully restored. You may need to see a nutritionist to help with returning to a healthy diet. This is particularly helpful if you have not been eating or have lost a lot of weight. […] Median arcuate ligament syndrome (MALS) care at Mayo Clinic

• #39 Median arcuate ligament syndrome (MALS) | UM Health-Sparrow

  https://www.uofmhealthsparrow.org/departments-conditions/conditions/median-arcuate-ligament-syndrome-mals

  Median arcuate ligament syndrome, also called MALS, happens when the band of tissue in the upper belly area presses on the artery that sends blood to the stomach, spleen and liver. This tissue is called the median arcuate ligament. The artery is called the celiac artery. […] Treatment involves surgery to release pressure from the ligament on the artery and nerves. […] Surgery is the only treatment for median arcuate ligament syndrome, also called MALS. Surgery for MALS can improve or reduce symptoms in most people. […] During decompression surgery, the surgeon cuts away parts of the median arcuate ligament. This reduces pressure on the celiac artery and nerves. […] If you have MALS release surgery, you usually stay in the hospital for 2 to 3 days. You may have an ultrasound or a CT scan about a month after surgery to make sure that blood flow is fully restored. You may need to see a nutritionist to help with returning to a healthy diet. This is particularly helpful if you have not been eating or have lost a lot of weight.

• #40 Median Arcuate Ligament Syndrome (MALS): Symptoms and Treatment – UChicago Medicine

  https://www.uchicagomedicine.org/conditions-services/heart-vascular/vascular-disease/median-arcuate-ligament-syndrome

  Care of the incisions: The laparoscopic sites will have a shiny substance over them called Dermabond. Although we will allow bathing within a few days after surgery, the Dermabond over the incisions should not be scrubbed off or removed. The Dermabond will disappear on its own. This may take several weeks. […] Activity: You should not do any heavy lifting, strenuous activity or sports until you are cleared by the surgeon. […] Diet: You can eat a regular diet; however, it is recommended that you eat several small meals, rather than a few large meals. Constipation is common after surgery. Anesthesia and pain medication can contribute to constipation. You should drink plenty of water and avoid beverages with caffeine or alcohol in them. […] Medication: It is important to take the pain medications as directed by the surgeon. If the pain is not under control, you should contact your physician. […] Call us if there are any questions or if there is bleeding or drainage from the incision sites, fever over 101F, vomiting or a decrease in urinary output.

• #41 Median Arcuate Ligament Syndrome (MALS): Symptoms and Treatment – UChicago Medicine

  https://www.uchicagomedicine.org/conditions-services/heart-vascular/vascular-disease/median-arcuate-ligament-syndrome

  Care of the incisions: The laparoscopic sites will have a shiny substance over them called Dermabond. Although we will allow bathing within a few days after surgery, the Dermabond over the incisions should not be scrubbed off or removed. The Dermabond will disappear on its own. This may take several weeks. […] Activity: You should not do any heavy lifting, strenuous activity or sports until you are cleared by the surgeon. […] Diet: You can eat a regular diet; however, it is recommended that you eat several small meals, rather than a few large meals. Constipation is common after surgery. Anesthesia and pain medication can contribute to constipation. You should drink plenty of water and avoid beverages with caffeine or alcohol in them. […] Medication: It is important to take the pain medications as directed by the surgeon. If the pain is not under control, you should contact your physician. […] Call us if there are any questions or if there is bleeding or drainage from the incision sites, fever over 101F, vomiting or a decrease in urinary output.

• #42 Median Arcuate Ligament Syndrome (MALS): Symptoms and Treatment – UChicago Medicine

  https://www.uchicagomedicine.org/conditions-services/heart-vascular/vascular-disease/median-arcuate-ligament-syndrome

  Care of the incisions: The laparoscopic sites will have a shiny substance over them called Dermabond. Although we will allow bathing within a few days after surgery, the Dermabond over the incisions should not be scrubbed off or removed. The Dermabond will disappear on its own. This may take several weeks. […] Activity: You should not do any heavy lifting, strenuous activity or sports until you are cleared by the surgeon. […] Diet: You can eat a regular diet; however, it is recommended that you eat several small meals, rather than a few large meals. Constipation is common after surgery. Anesthesia and pain medication can contribute to constipation. You should drink plenty of water and avoid beverages with caffeine or alcohol in them. […] Medication: It is important to take the pain medications as directed by the surgeon. If the pain is not under control, you should contact your physician. […] Call us if there are any questions or if there is bleeding or drainage from the incision sites, fever over 101F, vomiting or a decrease in urinary output.

• #43 Median Arcuate Ligament Syndrome (MALS): Symptoms and Treatment – UChicago Medicine

  https://www.uchicagomedicine.org/conditions-services/heart-vascular/vascular-disease/median-arcuate-ligament-syndrome

  Care of the incisions: The laparoscopic sites will have a shiny substance over them called Dermabond. Although we will allow bathing within a few days after surgery, the Dermabond over the incisions should not be scrubbed off or removed. The Dermabond will disappear on its own. This may take several weeks. […] Activity: You should not do any heavy lifting, strenuous activity or sports until you are cleared by the surgeon. […] Diet: You can eat a regular diet; however, it is recommended that you eat several small meals, rather than a few large meals. Constipation is common after surgery. Anesthesia and pain medication can contribute to constipation. You should drink plenty of water and avoid beverages with caffeine or alcohol in them. […] Medication: It is important to take the pain medications as directed by the surgeon. If the pain is not under control, you should contact your physician. […] Call us if there are any questions or if there is bleeding or drainage from the incision sites, fever over 101F, vomiting or a decrease in urinary output.

• #44 Median Arcuate Ligament Syndrome (MALS): Symptoms and Treatment – UChicago Medicine

  https://www.uchicagomedicine.org/conditions-services/heart-vascular/vascular-disease/median-arcuate-ligament-syndrome

  Care of the incisions: The laparoscopic sites will have a shiny substance over them called Dermabond. Although we will allow bathing within a few days after surgery, the Dermabond over the incisions should not be scrubbed off or removed. The Dermabond will disappear on its own. This may take several weeks. […] Activity: You should not do any heavy lifting, strenuous activity or sports until you are cleared by the surgeon. […] Diet: You can eat a regular diet; however, it is recommended that you eat several small meals, rather than a few large meals. Constipation is common after surgery. Anesthesia and pain medication can contribute to constipation. You should drink plenty of water and avoid beverages with caffeine or alcohol in them. […] Medication: It is important to take the pain medications as directed by the surgeon. If the pain is not under control, you should contact your physician. […] Call us if there are any questions or if there is bleeding or drainage from the incision sites, fever over 101F, vomiting or a decrease in urinary output.

• #45 Median Arcuate Ligament Syndrome (MALS) | University Hospitals | University Hospitals

  https://www.uhhospitals.org/services/heart-and-vascular-services/conditions-and-treatments/vascular-disease/median-arcuate-ligament-syndrome

  Presently, the only treatment option for MALS is surgery. The most common such procedure is called a median arcuate ligament release, or median arcuate ligament decompression, which is done to reduce painful compression of the median arcuate ligament on the celiac artery. This surgery is increasingly performed as a minimally invasive (laparoscopic or robotic) procedure but is also done as traditional open surgery. […] Most patients who get laparoscopic surgery for MALS stay one night in the hospital and are able to resume a normal diet the following morning. Patients receive medication to relieve any pain or discomfort caused by the incisions. […] Most people who have surgery for MALS will have a duplex ultrasound a month after their procedure to check to see that there is no further compression of the median arcuate ligament.

• #46 Median arcuate ligament syndrome (MALS) | UM Health-Sparrow

  https://www.uofmhealthsparrow.org/departments-conditions/conditions/median-arcuate-ligament-syndrome-mals

  Median arcuate ligament syndrome, also called MALS, happens when the band of tissue in the upper belly area presses on the artery that sends blood to the stomach, spleen and liver. This tissue is called the median arcuate ligament. The artery is called the celiac artery. […] Treatment involves surgery to release pressure from the ligament on the artery and nerves. […] Surgery is the only treatment for median arcuate ligament syndrome, also called MALS. Surgery for MALS can improve or reduce symptoms in most people. […] During decompression surgery, the surgeon cuts away parts of the median arcuate ligament. This reduces pressure on the celiac artery and nerves. […] If you have MALS release surgery, you usually stay in the hospital for 2 to 3 days. You may have an ultrasound or a CT scan about a month after surgery to make sure that blood flow is fully restored. You may need to see a nutritionist to help with returning to a healthy diet. This is particularly helpful if you have not been eating or have lost a lot of weight.

• #47 Median arcuate ligament syndrome (MALS)

  https://www.mymlc.com/health-information/diseases-and-conditions/m/median-arcuate-ligament-syndrome-mals/

  Median arcuate ligament syndrome (MALS) occurs when the arc-shaped band of tissue in the chest area (median arcuate ligament) presses on, or traps, the artery that supplies blood to the organs in your upper abdomen (celiac artery). […] Treatment involves surgery to release (decompress) the ligament and restore blood flow through the artery. […] Surgery is the only treatment option for MALS. The most common procedure is called median arcuate ligament release, or median arcuate ligament decompression. It’s usually done as an open surgery but sometimes can be done as a minimally invasive (laparoscopic or robotic) procedure. […] If you have MALS release surgery, you’ll usually stay in the hospital for two to three days. You’ll need an ultrasound about a month after surgery to confirm that blood flow through the celiac artery is fully restored. Several studies have shown that surgery to release the median arcuate ligament is safe, even in children with MALS. It often results in immediate pain relief and improves the person’s quality of life.

• #48

  https://www.amerikanhastanesi.org/mayo-clinic-care-network/mayo-clinic-health-information-library/diseases-conditions/median-arcuate-ligament-syndrome-mals

  Median arcuate ligament syndrome (MALS) occurs when the arc-shaped band of tissue in the chest area (median arcuate ligament) presses on the artery that sends blood to the upper abdomen. The artery is called the celiac artery. MALS can cause stomach pain in some people. […] Treatment involves surgery to release (decompress) the ligament and restore blood flow through the artery. […] Surgery is the only treatment option for MALS. The most common procedure is called median arcuate ligament release, or median arcuate ligament decompression. It’s usually done as an open surgery. Sometimes it can be done as a minimally invasive (laparoscopic or robotic) procedure. […] If you have MALS release surgery, you’ll usually stay in the hospital for 2 to 3 days. You’ll need an ultrasound about a month after surgery to confirm that blood flow through the celiac artery is fully restored. Several studies have shown that surgery to release the median arcuate ligament is safe, even in children with MALS. It often results in immediate pain relief and improves the person’s quality of life.

• #49 Caring for kids with MALS: It’s not all in their head – UChicago Medicine

  https://www.uchicagomedicine.org/forefront/pediatrics-articles/2024/january/mals-not-all-in-their-head

  For 70% to 80% of children with MALS, surgically releasing the median arcuate ligament with neurolysis results in diminished abdominal pain and improved quality of life. […] Regional and national referrals to Comers MALS program have increased over the last few years, indicating the growing awareness of pediatricians and pediatric gastroenterologists of the disorder. […] We are actively involved with the MALS Foundation, a nonprofit started by several of our patients and parents of patients, to increase awareness and education of patients and providers about MALS, Skelly said. Chronic abdominal pain is devastating for kids. If surgery can resolve their pain, it can change the trajectory of their lives.

• #50 Median Arcuate Ligament Syndrome: Management and Literature Review

  https://pmc.ncbi.nlm.nih.gov/articles/PMC9542491/

  Both patients had surgical interventions. Ligament release is performed through open, laparoscopic, or robotic surgery. […] The aim of the surgery is to release the MAL, decompress the celiac artery, and release the celiac plexus. […] Both of these patients made full recoveries. Data on patient prognosis are beginning to emerge as the quality of medical care continues to improve. A cure rate of about 80% has been postulated by some authors. […] Prompt diagnosis and treatment following suspicion of the syndrome are critical for resolving symptoms and improving patients quality of life.

• #51 MALS (Median Arcuate Ligament Syndrome): Symptoms & Diagnosis

  https://my.clevelandclinic.org/health/diseases/16635-median-arcuate-ligament-syndrome-mals

  Median arcuate ligament syndrome (MALS) is a very rare disease in which the median arcuate ligament presses on your celiac artery and nearby nerves (celiac plexus). Treatment is surgery to separate the ligament from the celiac artery and celiac plexus. […] MALS is an unusual disease that causes physical and mental health issues. So, you can expect to have a whole team of specialists working to help you find relief, including gastroenterologists, general surgeons, vascular surgeons, pain management specialists, psychologists, and dietitians. […] Your healthcare provider may recommend a celiac plexus block to help ease stomach pain. They may recommend median arcuate ligament release, which is surgery to remove or release your ligament so it’s not pressing on your celiac artery. This procedure restores blood flow through your celiac artery and removes pressure on nearby nerves. […] MALS symptoms can come back after surgery. You should contact your care team if that happens.

• #52

  https://journals.lww.com/ajg/fulltext/2021/10001/s3575_recurrence_of_median_arcuate_ligament.3579.aspx

  Median arcuate ligament syndrome (MALS) is a rare condition associated with recurrent abdominal pain due to compression of the celiac artery by the median arcuate ligament. Decompression of median arcuate ligament is one of the mainstays in management. […] Despite intervention, patient had minimal improvement of symptoms, resulting in frequent ER visits and hospitalizations. […] Surgical management with decompression of the median arcuate ligament can provide symptomatic relief with varied results and high chances for recurrence, as seen in our case. […] Patients with recurrence will require re-evaluation for possible re-narrowing of the celiac artery, which results in scarring of the arterial wall and may require additional revascularization procedures such as balloon angioplasty. […] Therefore further studies to establish more effective management can lead to improved patient care and a decrease in hospital resources.

• #53 MALS (Median Arcuate Ligament Syndrome): Symptoms & Diagnosis

  https://my.clevelandclinic.org/health/diseases/16635-median-arcuate-ligament-syndrome-mals

  Median arcuate ligament syndrome (MALS) is a very rare disease in which the median arcuate ligament presses on your celiac artery and nearby nerves (celiac plexus). Treatment is surgery to separate the ligament from the celiac artery and celiac plexus. […] MALS is an unusual disease that causes physical and mental health issues. So, you can expect to have a whole team of specialists working to help you find relief, including gastroenterologists, general surgeons, vascular surgeons, pain management specialists, psychologists, and dietitians. […] Your healthcare provider may recommend a celiac plexus block to help ease stomach pain. They may recommend median arcuate ligament release, which is surgery to remove or release your ligament so it’s not pressing on your celiac artery. This procedure restores blood flow through your celiac artery and removes pressure on nearby nerves. […] MALS symptoms can come back after surgery. You should contact your care team if that happens.

• #54 The Importance of Multidisciplinary Care for MALS Patients Integrating Surgical Nutritional and Psychological Approaches – The University of Chicago MALS Program

  https://www.ucmals.com/the-importance-of-multidisciplinary-care-for-mals/

  Patients diagnosed with Median Arcuate Ligament Syndrome (MALS) require a multidisciplinary approach to their care. […] A multidisciplinary approach to the care of MALS patients is crucial for effectively managing the condition and improving patient outcomes. The integration of surgical, nutritional, and psychological approaches ensures that all aspects of the syndrome are addressed. […] A multidisciplinary care team consisting of surgeons, gastroenterologists, nutritionists, and psychologists is essential for providing comprehensive and holistic care to MALS patients. […] The importance of integrating surgical, nutritional, and psychological approaches in the care of MALS patients cannot be overstated. A multidisciplinary approach offers numerous advantages, including comprehensive treatment, teamwork, individualized care, continuity of care, and holistic support.

• #55 UT Physicians | Median arcuate ligament syndrome (MALS)

  https://www.utphysicians.com/median-arcuate-ligament-syndrome/

  Median arcuate ligament syndrome (MALS) is an uncommon condition that predominantly affects young individuals due to excessive compression of the celiac artery, the first large branch of the abdominal aorta located near the median arcuate ligament and celiac ganglion. The diagnosis of MALS can be difficult because most patients present with nonspecific upper abdominal pain and because compression of the artery itself is not sufficient to determine cause and effect. […] Patients with MALS often undergo a multidisciplinary evaluation with several specialties including gastroenterology, vascular surgery, general surgery, cardiology, anesthesia pain management, interventional radiology, and psychological assessment. […] A surgical consultation with an expert on MALS treatment is needed once the diagnosis is contemplated.

• #56 MALS: Causes, Symptoms & Treatment | Dr. Joshua Tierney

  https://www.drjoshuatierney.com/conditions/vascular/mals/

  Median Arcuate Ligament Syndrome (MALS) is a rare but potentially debilitating condition caused by the compression of the celiac artery by the median arcuate ligament. This anatomical abnormality can restrict blood flow through the celiac artery to major abdominal organs, leading to symptoms that are often mistaken for other gastrointestinal disorders. Patients with MALS commonly experience epigastric pain, chronic abdominal pain, nausea, vomiting, and unintentional weight loss. […] Effective management of MALS often involves a team of specialists, including gastroenterologists, vascular surgeons, and pain management experts, working together to provide comprehensive and personalized care. This collaborative approach is critical for the management of median arcuate ligament syndrome and the surgical treatment of MALS.

• #57 Median Arcuate Ligament Syndrome | Society for Vascular Surgery

  https://vascular.org/node/1845

  Treatment for MALS may involve laparoscopic or robotic ligament release, performed by non-vascular surgeons. Vascular surgeons may recommend additional arterial interventions such as ballooning, stenting, or open surgery if necessary. Collaboration among all the patients health care providers ensures the best possible outcomes.

• #58 Median arcuate ligament syndrome: When to consider the diagnosis and management options

  https://www1.racgp.org.au/ajgp/2024/supplement-december/median-arcuate-ligament-syndrome

  Median arcuate ligament syndrome (MALS) occurs due to extrinsic compression of the coeliac plexus, leading to postprandial and exercise-induced epigastric pain, nausea, vomiting, food fear and weight loss. […] Primary care physicians are commonly the first people to encounter patients with MALS and play a vital role in its assessment, diagnosis and management and the coordination of subspecialty care. […] The primary presenting symptom of MALS is abdominal pain. Determining a diagnosis for chronic abdominal pain can be challenging due to the broad differentials and extensive work-up required, along with the significant effects on the patients quality of life. […] MALS occurs most commonly in young women. They describe abdominal pain, weight loss, bloating, nausea and vomiting, which can be related to eating and drinking or be exercise induced.

• #59 Median arcuate ligament syndrome (MALS) | Beacon Health System

  https://www.beaconhealthsystem.org/library/diseases-and-conditions/median-arcuate-ligament-syndrome-mals?content_id=CON-20459603

  Stomach pain after eating isn’t always indigestion. It could be MALS, also called celiac artery compression. Know the warning symptoms. […] Treatment involves surgery to release pressure from the ligament on the artery and nerves. […] Surgery is the only treatment for median arcuate ligament syndrome, also called MALS. Surgery for MALS can improve or reduce symptoms in most people. […] If you have MALS release surgery, you usually stay in the hospital for 2 to 3 days. You may have an ultrasound or a CT scan about a month after surgery to make sure that blood flow is fully restored. You may need to see a nutritionist to help with returning to a healthy diet. This is particularly helpful if you have not been eating or have lost a lot of weight. […] Living with MALS may make you feel sad, anxious or depressed. The challenge of getting an accurate diagnosis may be overwhelming. Sharing your thoughts and feelings with others who have similar experiences may be helpful. A support group can provide emotional support and help you learn new coping skills.

• #60 Median arcuate ligament syndrome (MALS) – Augusta HealthSearchClose SearchSearch IconSearch IconClose Search IconMobile Menu IconMobile Menu Close IconInstagramFacebookTwitterYoutube

  https://www.augustahealth.com/disease/median-arcuate-ligament-syndrome-mals/

  Living with MALS may make you feel sad, anxious or depressed. The challenge of getting an accurate diagnosis — and having so many medical tests — may be overwhelming. Sharing your thoughts and feelings with others who have similar experiences may be helpful. A support group can provide emotional support and help you learn about new coping skills. The National MALS Foundation provides information and connections for people with median arcuate ligament syndrome. Or, ask your doctor, clinic or hospital if they can recommend a support group in your area.

• #61 Caring for kids with MALS: It’s not all in their head – UChicago Medicine

  https://www.uchicagomedicine.org/forefront/pediatrics-articles/2024/january/mals-not-all-in-their-head

  Our multidisciplinary program allows us to identify those patients whose pain is most likely caused by the compression and who will benefit from surgery, said Mak. […] About half of pediatric patients with symptomatic MALS have at least one co-morbid psychiatric disorder, including depression and/or anxiety. […] If mental health problems are not addressed, at least half of these kids will continue to have psychiatric conditions following surgery that successfully relieves their pain, said Drossos, who has published research with Skelly and Mak on the psychological factors and outcomes in children with MALS. […] Unresolved mental health issues can be just as debilitating and impactful on a childs overall well-being as an anatomical anomaly that causes stomach pain, she said. […] Comorbid psychiatric problems can also lead to suboptimal surgical outcomes. Mental health problems can affect childrens physical recovery from surgery and can cause continuing stomach pain despite a successful surgical outcome, said Drossos.

• #62 Caring for kids with MALS: It’s not all in their head – UChicago Medicine

  https://www.uchicagomedicine.org/forefront/pediatrics-articles/2024/january/mals-not-all-in-their-head

  Our multidisciplinary program allows us to identify those patients whose pain is most likely caused by the compression and who will benefit from surgery, said Mak. […] About half of pediatric patients with symptomatic MALS have at least one co-morbid psychiatric disorder, including depression and/or anxiety. […] If mental health problems are not addressed, at least half of these kids will continue to have psychiatric conditions following surgery that successfully relieves their pain, said Drossos, who has published research with Skelly and Mak on the psychological factors and outcomes in children with MALS. […] Unresolved mental health issues can be just as debilitating and impactful on a childs overall well-being as an anatomical anomaly that causes stomach pain, she said. […] Comorbid psychiatric problems can also lead to suboptimal surgical outcomes. Mental health problems can affect childrens physical recovery from surgery and can cause continuing stomach pain despite a successful surgical outcome, said Drossos.

• #63 Median arcuate ligament syndrome (MALS) | Beacon Health System

  https://www.beaconhealthsystem.org/library/diseases-and-conditions/median-arcuate-ligament-syndrome-mals?content_id=CON-20459603

  Stomach pain after eating isn’t always indigestion. It could be MALS, also called celiac artery compression. Know the warning symptoms. […] Treatment involves surgery to release pressure from the ligament on the artery and nerves. […] Surgery is the only treatment for median arcuate ligament syndrome, also called MALS. Surgery for MALS can improve or reduce symptoms in most people. […] If you have MALS release surgery, you usually stay in the hospital for 2 to 3 days. You may have an ultrasound or a CT scan about a month after surgery to make sure that blood flow is fully restored. You may need to see a nutritionist to help with returning to a healthy diet. This is particularly helpful if you have not been eating or have lost a lot of weight. […] Living with MALS may make you feel sad, anxious or depressed. The challenge of getting an accurate diagnosis may be overwhelming. Sharing your thoughts and feelings with others who have similar experiences may be helpful. A support group can provide emotional support and help you learn new coping skills.

• #64 Median arcuate ligament syndrome (MALS) – Augusta HealthSearchClose SearchSearch IconSearch IconClose Search IconMobile Menu IconMobile Menu Close IconInstagramFacebookTwitterYoutube

  https://www.augustahealth.com/disease/median-arcuate-ligament-syndrome-mals/

  Living with MALS may make you feel sad, anxious or depressed. The challenge of getting an accurate diagnosis — and having so many medical tests — may be overwhelming. Sharing your thoughts and feelings with others who have similar experiences may be helpful. A support group can provide emotional support and help you learn about new coping skills. The National MALS Foundation provides information and connections for people with median arcuate ligament syndrome. Or, ask your doctor, clinic or hospital if they can recommend a support group in your area.

• #65 Median arcuate ligament syndrome (MALS) – Diagnosis and treatment – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/median-arcuate-ligament-syndrome-mals/diagnosis-treatment/drc-20505007

  Our caring team of Mayo Clinic experts can help you with your median arcuate ligament syndrome (mals)-related health concerns […] Surgery is the only treatment for median arcuate ligament syndrome, also called MALS. Surgery for MALS can improve or reduce symptoms in most people. […] If you have MALS release surgery, you usually stay in the hospital for 2 to 3 days. You may have an ultrasound or a CT scan about a month after surgery to make sure that blood flow is fully restored. You may need to see a nutritionist to help with returning to a healthy diet. This is particularly helpful if you have not been eating or have lost a lot of weight. […] Median arcuate ligament syndrome (MALS) care at Mayo Clinic

• #66 Median arcuate ligament syndrome (MALS) | UM Health-Sparrow

  https://www.uofmhealthsparrow.org/departments-conditions/conditions/median-arcuate-ligament-syndrome-mals

  Median arcuate ligament syndrome, also called MALS, happens when the band of tissue in the upper belly area presses on the artery that sends blood to the stomach, spleen and liver. This tissue is called the median arcuate ligament. The artery is called the celiac artery. […] Treatment involves surgery to release pressure from the ligament on the artery and nerves. […] Surgery is the only treatment for median arcuate ligament syndrome, also called MALS. Surgery for MALS can improve or reduce symptoms in most people. […] During decompression surgery, the surgeon cuts away parts of the median arcuate ligament. This reduces pressure on the celiac artery and nerves. […] If you have MALS release surgery, you usually stay in the hospital for 2 to 3 days. You may have an ultrasound or a CT scan about a month after surgery to make sure that blood flow is fully restored. You may need to see a nutritionist to help with returning to a healthy diet. This is particularly helpful if you have not been eating or have lost a lot of weight.

• #67 Median Arcuate Ligament Syndrome (MALS): An In-depth Analysis – Longmore Clinic

  https://longmoreclinic.org/median-arcuate-ligament-syndrome-mals-an-in-depth-analysis/

  There is no known way to prevent MALS, as it results from an anatomical variation that is present from birth. However, individuals can take steps to manage their symptoms and improve their quality of life: Adopting a balanced diet: Eating smaller, more frequent meals can help reduce the severity of abdominal pain after eating. Maintaining a healthy weight: Gaining some weight, especially in underweight individuals, can help reduce symptoms by providing extra cushioning around the celiac artery. Seeking medical attention: Early diagnosis and treatment can help prevent complications and improve the overall quality of life. […] If you experience persistent abdominal pain, especially after eating, its essential to seek medical attention. Early diagnosis and treatment can help reduce discomfort and improve your quality of life. MALS can be challenging to diagnose, as its symptoms overlap with other conditions. A healthcare professional may order imaging studies, such as CT scans or MRIs, to visualize the blood vessels and assess for celiac artery compression.

• #68 Median Arcuate Ligament Syndrome (MALS): An In-depth Analysis – Longmore Clinic

  https://longmoreclinic.org/median-arcuate-ligament-syndrome-mals-an-in-depth-analysis/

  The treatment of MALS depends on the severity of symptoms and the degree of celiac artery compression. Options include: Dietary Changes: Eating smaller, more frequent meals can help alleviate symptoms. Pain Management: Medications like nonsteroidal anti-inflammatory drugs (NSAIDs) or antispasmodics may be prescribed to manage abdominal pain. Surgery: In severe cases, surgery may be recommended to release the median arcuate ligament and relieve compression of the celiac artery. […] Median Arcuate Ligament Syndrome (MALS) is a rare vascular condition characterized by abdominal pain resulting from compression of the celiac artery. Although it can be challenging to diagnose and manage, with proper medical care, individuals with MALS can lead fulfilling lives. If you suspect you may have MALS, consult a healthcare professional for a comprehensive evaluation and personalized treatment plan.

• #69 Caring for kids with MALS: It’s not all in their head – UChicago Medicine

  https://www.uchicagomedicine.org/forefront/pediatrics-articles/2024/january/mals-not-all-in-their-head

  Importantly, a comprehensive psychological assessment — in-person for local patients and via Zoom for children living out of state or internationally — can also help determine if a childs symptoms are the result of a psychiatric disorder rather than MALS. […] After reviewing each childs medical and psychological findings, the MALS team determines whether surgery and a presurgical mental health intervention are warranted. […] Most of the time we recommend individual cognitive behavioral therapy, which can be done at Comer or elsewhere. […] Children are followed for a year post-surgery, a period where they will often continue mental health therapy. […] It can be challenging to begin eating normally again after months or even years of restricting food to avoid pain, said Drossos. […] Surgery to release the median arcuate ligament in children is nearly always performed laparoscopically at Comer, and jointly by Mak and Skelly, a unique pairing of surgeons.

• #70 Clinically Significant Progression of Median Arcuate Ligament Syndrome – Madigan | Wake Forest University School of Medicine

  https://school.wakehealth.edu/about-the-school/wake-forest-journal-of-science-and-medicine/summer-2021/clinically-significant-progression-of-median-arcuate-ligament-syndrome

  Median arcuate ligament syndrome (MALS) is a poorly understood condition characterized by compression of the celiac artery by a fibrous ligament connecting the diaphragmatic crura. […] Given the severity of her debility, the patient was medically optimized before scheduled surgery for the treatment of her suspected MALS. […] In coordination with the care team, the patient had continual supplementation for her numerous vitamin and mineral deficiencies, including total parenteral nutrition to optimize the patient before later surgical intervention for the treatment of MALS. […] Recognition of MALS as a potential etiology in the diagnostic evaluation of abdominal pain is of growing clinical importance. […] Doppler vascular ultrasound to evaluate respiratory variation can help determine if compression is clinically significant and may be contributing to abdominal pain.

• #71 Median Arcuate Ligament Syndrome: Management and Literature Review

  https://pmc.ncbi.nlm.nih.gov/articles/PMC9542491/

  Pain, nausea, vomiting, weight loss, diarrhea, and fatigue are common symptoms of several upper gastroenterological illnesses. However, the presence of unexplained recurring postprandial abdominal pain and vomiting increases the possibility of median arcuate ligament syndrome (MALS). MALS is an uncommon illness characterized by postprandial vomiting, abdominal pain, and weight loss. […] Accurate diagnosis is key to reducing time and resources, establishing a cure, and restoring a patients quality of life. […] Therefore, it is essential to consider MALS when evaluating a patient with these upper gastroenterological symptoms. […] Surgery has consistently been reported as a potential management option. If not diagnosed and managed appropriately, common complications such as electrolyte imbalance and its manifestation, prodromes of malnutrition, and possible psychosomatic disorders such as anxiety may arise.

• #72 Median arcuate ligament syndrome: Incidental finding or real problem? | Cleveland Clinic Journal of Medicine

  https://www.ccjm.org/content/88/3/140

  The median arcuate ligament is a fibrous arch connecting the crura of the diaphragm forming the aortic hiatus and lying superior to the celiac artery. MALS, also known as Dunbar syndrome or celiac artery compression syndrome, is a rare phenomenon caused by extrinsic compression of the celiac trunk by the median arcuate ligament. […] MALS is considered a diagnosis of exclusion, and it can coexist with other intra-abdominal pathologies and be a confounding factor. […] To enhance the benefit of surgical intervention, studies aimed at improving the ability to reliably diagnose MALS are required. Surgery should be reserved for patients who would benefit from it, and patient selection continues to be challenging, as there is relatively poor correlation between the radiographic findings of celiac artery compression and the presence or severity of symptoms. It is generally accepted that asymptomatic or incidentally discovered MALS does not warrant intervention.

• #73 Median arcuate ligament syndrome: When to consider the diagnosis and management options

  https://www1.racgp.org.au/ajgp/2024/supplement-december/median-arcuate-ligament-syndrome

  If appropriate, intervention for MALS requires a multidisciplinary approach, including vascular surgery, general surgery, pain specialists and interventional radiology. […] Coeliac plexus block is a non-surgical option for relief from MALS that can also aide as a diagnostic test. […] The surgical treatment of MALS includes decompressing the artery and performing a coeliac ganglionectomy. […] On reviewing the literature, we have proposed a diagnostic and treatment pathway. […] Due to the challenges in both diagnosis and treatment of MALS, multidisciplinary care involving general practitioners along with subspecialists is vital for successful outcomes. […] Those with MALS who have appropriate work-up, diagnosis and management have been found to have good outcomes in case series.

• #74 MALS: Causes, Symptoms & Treatment | Dr. Joshua Tierney

  https://www.drjoshuatierney.com/conditions/vascular/mals/

  Before undergoing surgery for MALS, the preoperative process generally involves the following steps: Comprehensive evaluation, including medical history and imaging studies. Discussion of surgery’s risks and benefits. Dietary guidelines and medication adjustments leading up to surgery. Preoperative instructions provided by Dr. Tierney. Possible trial of lifestyle modifications or medications before surgery. […] The type of surgical procedure you undergo will determine the post-operative care required. Generally, post-surgery care involves: Significant reduction in symptoms such as abdominal pain, nausea, and weight loss. Quick recovery with most patients resuming activities within weeks. Pain management, follow-up imaging, and dietary recommendations for healing. Continuous support from Dr. Tierney’s team during recovery. Favorable long-term outcomes with lasting symptom relief for many patients.

• #75 Median Arcuate Ligament Syndrome (MALS): Symptoms and Treatment – UChicago Medicine

  https://www.uchicagomedicine.org/conditions-services/heart-vascular/vascular-disease/median-arcuate-ligament-syndrome

  Care of the incisions: The laparoscopic sites will have a shiny substance over them called Dermabond. Although we will allow bathing within a few days after surgery, the Dermabond over the incisions should not be scrubbed off or removed. The Dermabond will disappear on its own. This may take several weeks. […] Activity: You should not do any heavy lifting, strenuous activity or sports until you are cleared by the surgeon. […] Diet: You can eat a regular diet; however, it is recommended that you eat several small meals, rather than a few large meals. Constipation is common after surgery. Anesthesia and pain medication can contribute to constipation. You should drink plenty of water and avoid beverages with caffeine or alcohol in them. […] Medication: It is important to take the pain medications as directed by the surgeon. If the pain is not under control, you should contact your physician. […] Call us if there are any questions or if there is bleeding or drainage from the incision sites, fever over 101F, vomiting or a decrease in urinary output.

• #76 MALS | National MALS Foundation

  https://www.malsfoundation.org/what-is-mals

  Median Arcuate Ligament Syndrome is also known as: MALS, Celiac Artery Compression Syndrome (CACS), Dunbar Syndrome and Harjola-Marable Syndrome. […] The standard treatment is surgical release of the celiac artery by division of the median arcuate ligament (MAL) including overlying lymphatics and soft tissue with or without neurolysis of the compressed nerves and removal of scar tissue. […] Short and Long term follow up is recommended with vascular studies to reinforce continuity of care in the event of recurrence. […] Important for people to receive prompt accurate testing and initiate treatment plan to resolve or help reduce short or long term effects afflicted or inflicted by MALS. […] false

• #77 The Importance of Multidisciplinary Care for MALS Patients Integrating Surgical Nutritional and Psychological Approaches – The University of Chicago MALS Program

  https://www.ucmals.com/the-importance-of-multidisciplinary-care-for-mals/

  By integrating psychological approaches into multidisciplinary care, healthcare providers can better meet the needs of MALS patients and improve their overall well-being. […] Integrating nutritional strategies alongside surgical and psychological interventions plays a vital role in the multidisciplinary care of MALS patients. […] By integrating surgical, nutritional, psychological, and rehabilitation approaches, healthcare teams can maximize surgical outcomes for MALS patients.

• #78 MALS: Causes, Symptoms & Treatment | Dr. Joshua Tierney

  https://www.drjoshuatierney.com/conditions/vascular/mals/

  Before undergoing surgery for MALS, the preoperative process generally involves the following steps: Comprehensive evaluation, including medical history and imaging studies. Discussion of surgery’s risks and benefits. Dietary guidelines and medication adjustments leading up to surgery. Preoperative instructions provided by Dr. Tierney. Possible trial of lifestyle modifications or medications before surgery. […] The type of surgical procedure you undergo will determine the post-operative care required. Generally, post-surgery care involves: Significant reduction in symptoms such as abdominal pain, nausea, and weight loss. Quick recovery with most patients resuming activities within weeks. Pain management, follow-up imaging, and dietary recommendations for healing. Continuous support from Dr. Tierney’s team during recovery. Favorable long-term outcomes with lasting symptom relief for many patients.

• #79 A case report on median arcuate ligament syndrome: Need for a high index of suspicion – Medicine India

  https://medindiajournal.com/a-case-report-on-median-arcuate-ligament-syndrome-need-for-a-high-index-of-suspicion/

  The Median Arcuate Ligament Syndrome (MALS) is a rare clinical entity occurring due to abnormally low insertion of the ligament across the origin of the coeliac axis resulting in varying degrees of celiac artery compression. […] MALS should be considered as an important differential in patients with symptoms resembling post-prandial angina. A combination of a high index of suspicion with the use of appropriate imaging techniques can clinch this diagnosis. […] This case illustrates the classic clinical and imaging findings of this condition with an emphasis on the need for a high index of suspicion. […] The workup should exclude hepatobiliary pathology and gastric or duodenal ulcer disease because MALS is a diagnosis of exclusion. […] Ultrasound along with color and spectral Doppler imaging has emerged as a non-invasive, real-time, and dynamic screening tool that can increase diagnostic confidence. […] Surgical median arcuate ligament release has been the mainstay of treatment. […] This case confirms that MALS is a challenging diagnosis. Patients usually undergo extensive workup for their abdominal pain before this diagnosis is reached.

• #80 Median Arcuate Ligament Syndrome: Where Are We Today? – PubMed

  https://pubmed.ncbi.nlm.nih.gov/39418076/

  Median arcuate ligament syndrome, or celiac artery compression syndrome (eponym: Dunbar syndrome), has historically been attributed to pathophysiologic vascular compression causing downstream ischemic symptoms of the organs supplied by the celiac trunk. […] However, the more we learn about the histology, clinical presentation, and treatment outcomes, health care providers are increasingly correlating the symptoms of MALS with the long-term, repetitive compression of the celiac ganglion rather than the celiac trunk. This article provides a comprehensive review of current MALS literature, emphasizing the multidisciplinary approach these patients require in all phases of their care. […] With most patients with MALS waiting an average of 10.5 months to 2.6 years, our need for better diagnostic protocols and clearer understanding of the pathophysiology of the disease is paramount. Further investigation into patient outcomes, associated conditions, and linked pathophysiology would help better characterize this disease with hopes of moving it from a diagnosis of exclusion to one of standard work-up with decreased time to treatment and symptom relief for patients.

• #81 Median Arcuate Ligament Syndrome (MALS): An In-depth Analysis – Longmore Clinic

  https://longmoreclinic.org/median-arcuate-ligament-syndrome-mals-an-in-depth-analysis/

  The treatment of MALS depends on the severity of symptoms and the degree of celiac artery compression. Options include: Dietary Changes: Eating smaller, more frequent meals can help alleviate symptoms. Pain Management: Medications like nonsteroidal anti-inflammatory drugs (NSAIDs) or antispasmodics may be prescribed to manage abdominal pain. Surgery: In severe cases, surgery may be recommended to release the median arcuate ligament and relieve compression of the celiac artery. […] Median Arcuate Ligament Syndrome (MALS) is a rare vascular condition characterized by abdominal pain resulting from compression of the celiac artery. Although it can be challenging to diagnose and manage, with proper medical care, individuals with MALS can lead fulfilling lives. If you suspect you may have MALS, consult a healthcare professional for a comprehensive evaluation and personalized treatment plan.

• #82

  https://journals.lww.com/ajg/fulltext/2021/10001/s3575_recurrence_of_median_arcuate_ligament.3579.aspx

  Median arcuate ligament syndrome (MALS) is a rare condition associated with recurrent abdominal pain due to compression of the celiac artery by the median arcuate ligament. Decompression of median arcuate ligament is one of the mainstays in management. […] Despite intervention, patient had minimal improvement of symptoms, resulting in frequent ER visits and hospitalizations. […] Surgical management with decompression of the median arcuate ligament can provide symptomatic relief with varied results and high chances for recurrence, as seen in our case. […] Patients with recurrence will require re-evaluation for possible re-narrowing of the celiac artery, which results in scarring of the arterial wall and may require additional revascularization procedures such as balloon angioplasty. […] Therefore further studies to establish more effective management can lead to improved patient care and a decrease in hospital resources.

• #83 Caring for kids with MALS: It’s not all in their head – UChicago Medicine

  https://www.uchicagomedicine.org/forefront/pediatrics-articles/2024/january/mals-not-all-in-their-head

  Our multidisciplinary program allows us to identify those patients whose pain is most likely caused by the compression and who will benefit from surgery, said Mak. […] About half of pediatric patients with symptomatic MALS have at least one co-morbid psychiatric disorder, including depression and/or anxiety. […] If mental health problems are not addressed, at least half of these kids will continue to have psychiatric conditions following surgery that successfully relieves their pain, said Drossos, who has published research with Skelly and Mak on the psychological factors and outcomes in children with MALS. […] Unresolved mental health issues can be just as debilitating and impactful on a childs overall well-being as an anatomical anomaly that causes stomach pain, she said. […] Comorbid psychiatric problems can also lead to suboptimal surgical outcomes. Mental health problems can affect childrens physical recovery from surgery and can cause continuing stomach pain despite a successful surgical outcome, said Drossos.

• #84 Median Arcuate Ligament Syndrome: Management and Literature Review

  https://pmc.ncbi.nlm.nih.gov/articles/PMC9542491/

  Pain, nausea, vomiting, weight loss, diarrhea, and fatigue are common symptoms of several upper gastroenterological illnesses. However, the presence of unexplained recurring postprandial abdominal pain and vomiting increases the possibility of median arcuate ligament syndrome (MALS). MALS is an uncommon illness characterized by postprandial vomiting, abdominal pain, and weight loss. […] Accurate diagnosis is key to reducing time and resources, establishing a cure, and restoring a patients quality of life. […] Therefore, it is essential to consider MALS when evaluating a patient with these upper gastroenterological symptoms. […] Surgery has consistently been reported as a potential management option. If not diagnosed and managed appropriately, common complications such as electrolyte imbalance and its manifestation, prodromes of malnutrition, and possible psychosomatic disorders such as anxiety may arise.

• #85 Median Arcuate Ligament Syndrome: Management and Literature Review

  https://pmc.ncbi.nlm.nih.gov/articles/PMC9542491/

  Both patients had surgical interventions. Ligament release is performed through open, laparoscopic, or robotic surgery. […] The aim of the surgery is to release the MAL, decompress the celiac artery, and release the celiac plexus. […] Both of these patients made full recoveries. Data on patient prognosis are beginning to emerge as the quality of medical care continues to improve. A cure rate of about 80% has been postulated by some authors. […] Prompt diagnosis and treatment following suspicion of the syndrome are critical for resolving symptoms and improving patients quality of life.

• #86 A case report on median arcuate ligament syndrome: Need for a high index of suspicion – Medicine India

  https://medindiajournal.com/a-case-report-on-median-arcuate-ligament-syndrome-need-for-a-high-index-of-suspicion/

  The Median Arcuate Ligament Syndrome (MALS) is a rare clinical entity occurring due to abnormally low insertion of the ligament across the origin of the coeliac axis resulting in varying degrees of celiac artery compression. […] MALS should be considered as an important differential in patients with symptoms resembling post-prandial angina. A combination of a high index of suspicion with the use of appropriate imaging techniques can clinch this diagnosis. […] This case illustrates the classic clinical and imaging findings of this condition with an emphasis on the need for a high index of suspicion. […] The workup should exclude hepatobiliary pathology and gastric or duodenal ulcer disease because MALS is a diagnosis of exclusion. […] Ultrasound along with color and spectral Doppler imaging has emerged as a non-invasive, real-time, and dynamic screening tool that can increase diagnostic confidence. […] Surgical median arcuate ligament release has been the mainstay of treatment. […] This case confirms that MALS is a challenging diagnosis. Patients usually undergo extensive workup for their abdominal pain before this diagnosis is reached.

• #87 Median arcuate ligament syndrome: When to consider the diagnosis and management options

  https://www1.racgp.org.au/ajgp/2024/supplement-december/median-arcuate-ligament-syndrome

  MALS does not have universally accepted diagnostic criteria. […] However, it is a diagnosis that remains one of relative exclusion and is typically the result of extensive investigations to exclude more common, alternative causes of abdominal pain. […] Recommended work-up includes targeted blood tests (full blood count and liver function, renal function and lipase/amylase tests), urinary culture, biliary ultrasound, and upper and lower endoscopies with Helicobacter pylori testing and food allergy testing, including coeliac disease. […] If the above investigations are normal, along with a finding of coeliac artery compression, a diagnosis of MALS should be considered and the patient would benefit from multidisciplinary input, including from a gastroenterologist and a vascular surgeon.

• #88 The Importance of Multidisciplinary Care for MALS Patients Integrating Surgical Nutritional and Psychological Approaches – The University of Chicago MALS Program

  https://www.ucmals.com/the-importance-of-multidisciplinary-care-for-mals/

  Patients diagnosed with Median Arcuate Ligament Syndrome (MALS) require a multidisciplinary approach to their care. […] A multidisciplinary approach to the care of MALS patients is crucial for effectively managing the condition and improving patient outcomes. The integration of surgical, nutritional, and psychological approaches ensures that all aspects of the syndrome are addressed. […] A multidisciplinary care team consisting of surgeons, gastroenterologists, nutritionists, and psychologists is essential for providing comprehensive and holistic care to MALS patients. […] The importance of integrating surgical, nutritional, and psychological approaches in the care of MALS patients cannot be overstated. A multidisciplinary approach offers numerous advantages, including comprehensive treatment, teamwork, individualized care, continuity of care, and holistic support.

• #89 Median Arcuate Ligament Syndrome Clinical Presentation, Pathophysiology, and Management: Description of Four Cases

  https://www.mdpi.com/2624-5647/3/1/5

  The definitive treatment is the surgical release of the median arcuate ligament to achieve decompression of the celiac plexus. […] Surgery is the definitive treatment to divide the median arcuate ligament to decompress the celiac artery and celiac plexus. […] The surgical approach of minimally invasive laparoscopic and robotic techniques focuses on ligating the ligament, and often times results in partial surgical disruption of the celiac plexus, thus overcoming the compression of the celiac ganglion from which the symptoms are emanating. Finally, it is important for the long-term follow-up of these patients to make sure that they are symptom-free, thus confirming the sustainability of the surgery and the accuracy of the diagnosis.

• #90 MALS | National MALS Foundation

  https://www.malsfoundation.org/what-is-mals

  Median Arcuate Ligament Syndrome is also known as: MALS, Celiac Artery Compression Syndrome (CACS), Dunbar Syndrome and Harjola-Marable Syndrome. […] The standard treatment is surgical release of the celiac artery by division of the median arcuate ligament (MAL) including overlying lymphatics and soft tissue with or without neurolysis of the compressed nerves and removal of scar tissue. […] Short and Long term follow up is recommended with vascular studies to reinforce continuity of care in the event of recurrence. […] Important for people to receive prompt accurate testing and initiate treatment plan to resolve or help reduce short or long term effects afflicted or inflicted by MALS. […] false

• #91 The Importance of Multidisciplinary Care for MALS Patients Integrating Surgical Nutritional and Psychological Approaches – The University of Chicago MALS Program

  https://www.ucmals.com/the-importance-of-multidisciplinary-care-for-mals/

  By integrating psychological approaches into multidisciplinary care, healthcare providers can better meet the needs of MALS patients and improve their overall well-being. […] Integrating nutritional strategies alongside surgical and psychological interventions plays a vital role in the multidisciplinary care of MALS patients. […] By integrating surgical, nutritional, psychological, and rehabilitation approaches, healthcare teams can maximize surgical outcomes for MALS patients.

• #92 What Is Median Arcuate Ligament Syndrome? – Klarity Health Library

  https://my.klarity.health/what-is-median-arcuate-ligament-syndrome/

  Median arcuate ligament syndrome (MALS), also known as celiac artery compression syndrome, is an uncommon condition caused by the pressure of the celiac artery by low riding of fibrous connections of the middle arcuate tendon and diaphragmatic crura. MALS is frequently hard to diagnose because of the vague symptoms of weight loss, abdominal pain, and early satiety. […] The treatment choice for MALS depends on the severity of symptoms and the patients overall health. Treatment options include conservative management, medication, interventional procedures, and surgical intervention. […] It is crucial to note that the understanding of MALS and its risk factors may evolve, and if you have concerns, you should seek advice from professionals regardless of gender. […] Early diagnosis and appropriate management can improve outcomes and MALS-related symptom reduction.

Zobacz więcej