Zespół więzadła łukowatego środkowego (mals)

Zespół więzadła łukowatego środkowego (mals)
Etiologia i przyczyny

Zespół więzadła łukowatego środkowego (MALS) to rzadkie schorzenie, w którym nieprawidłowo nisko położone więzadło łukowate środkowe uciska tętnicę trzewną oraz splot trzewny, prowadząc do niedokrwienia narządów jamy brzusznej (żołądek, wątroba, śledziona, trzustka) oraz neurogennego bólu. Etiologia MALS jest wieloczynnikowa i obejmuje wrodzone anomalie anatomiczne (np. wysokie odejście tętnicy trzewnej od aorty), czynniki genetyczne (np. zespół Marfana, Ehlersa-Danlosa), a także nabyte przyczyny, takie jak szybka utrata masy ciała czy urazy jamy brzusznej. Radiologicznie ucisk tętnicy trzewnej obserwuje się u 10-25% populacji, jednak tylko około 1% rozwija objawy kliniczne. Patofizjologia łączy komponenty naczyniowe (zwężenie tętnicy, hiperplazja błony wewnętrznej, niedokrwienie po posiłkach) z neurogennymi (podrażnienie splotu trzewnego, skurcz naczyń, zaburzenia motoryki żołądka). MALS dotyczy głównie kobiet w wieku 20-40 lat o szczupłej budowie ciała, a objawy mogą obejmować przewlekły ból brzucha, gastroparezę oraz zaburzenia psychiczne.

Etiologia zespołu więzadła łukowatego środkowego (MALS)

Zespół więzadła łukowatego środkowego (MALS), znany również jako zespół ucisku tętnicy trzewnej lub zespół Dunbara, jest rzadkim schorzeniem, które występuje, gdy więzadło łukowate środkowe w górnej części jamy brzusznej uciska tętnicę trzewną (zaopatrującą w krew żołądek, śledzionę i wątrobę) oraz otaczające ją struktury nerwowe (splot trzewny).¹² Dokładna przyczyna tego zespołu pozostaje przedmiotem dyskusji w środowisku medycznym, a etiologia MALS nie jest w pełni poznana.³⁴

Nieprawidłowości anatomiczne

Główną przyczyną zespołu więzadła łukowatego środkowego są nieprawidłowości anatomiczne związane z pozycją więzadła łukowatego środkowego i tętnicy trzewnej:⁵⁶

Nieprawidłowo nisko położone więzadło łukowate środkowe, które uciska tętnicę trzewną⁷⁸
Nieprawidłowo wysoko położone odejście tętnicy trzewnej od aorty (najbardziej powszechna przyczyna)⁹¹⁰
Nieprawidłowa pozycja przepony¹¹

U około 10-25% populacji stwierdza się radiologiczne cechy ucisku tętnicy trzewnej przez więzadło łukowate środkowe, jednak jedynie u około 1% osób ucisk ten prowadzi do objawów klinicznych.¹²¹³¹⁴

Czynniki wrodzone i rozwojowe

Istnieją przesłanki wskazujące na wrodzone podłoże zespołu MALS:¹⁵¹⁶

Przypadki MALS obserwowano u dzieci, a nawet u bliźniąt jednojajowych, co sugeruje możliwy udział czynników genetycznych¹⁷¹⁸
Wrodzone nieprawidłowości w rozwoju przepony lub pochodzeniu tętnicy trzewnej¹⁹
Błędy w rozwoju embrionalnym, prowadzące do nieprawidłowo niskiego przyczepu więzadła łukowatego środkowego²⁰

Możliwe są również czynniki rozwojowe, które mogą przyczyniać się do wystąpienia MALS, takie jak gwałtowne wzrosty wzrostu, zaburzenia tkanki łącznej czy lordoza kręgosłupa.²¹

Czynniki nabyte

Zespół więzadła łukowatego środkowego może również rozwinąć się w wyniku czynników nabytych:²²²³

Szybka utrata masy ciała – utrata ochronnej warstwy tłuszczu wokół tętnicy może zwiększyć prawdopodobieństwo ucisku²⁴²⁵
Uraz tępy górnej części jamy brzusznej²⁶²⁷
Przebyta operacja trzustki²⁸²⁹
Operacje kręgosłupa lub jamy brzusznej³⁰³¹
Zmiany anatomii przepony w wyniku urazu³²

Mechanizmy patofizjologiczne

Patofizjologia zespołu MALS jest złożona i prawdopodobnie obejmuje zarówno komponenty naczyniowe, jak i neurogeniczne:³³³⁴³⁵

Mechanizm niedokrwienny

Ucisk tętnicy trzewnej przez więzadło łukowate środkowe może prowadzić do:³⁶³⁷

Zmniejszenia przepływu krwi do narządów zaopatrywanych przez tętnicę trzewną (żołądek, wątroba, śledziona, trzustka)³⁸
Hiperplazji ściany wewnętrznej tętnicy trzewnej, prowadzącej do zwężenia jej światła³⁹⁴⁰
Niedokrwienia narządów jamy brzusznej, szczególnie widocznego po posiłkach, gdy zapotrzebowanie na krew wzrasta⁴¹
Poszerzenia postenotycznego tętnicy trzewnej⁴²⁴³

Niektórzy badacze sugerują istnienie tzw. „zjawiska podkradania”, gdzie z powodu znacznego krążenia obocznego krew jest odprowadzana od jelita środkowego do narządów zaopatrywanych przez tętnicę trzewną po posiłkach, powodując niedokrwienie jelita i ból.⁴⁴

Mechanizm neurogeniczny

Coraz więcej dowodów wskazuje na istotną rolę mechanizmu neurogenicznego w patogenezie MALS:⁴⁵⁴⁶

Ucisk i podrażnienie splotu trzewnego i zwoju trzewnego przez więzadło łukowate środkowe⁴⁷⁴⁸
Nadmierna stymulacja splotu trzewnego prowadząca do skurczu naczyń trzewnych i niedokrwienia⁴⁹⁵⁰
Zmiana aktywności elektrycznej żołądka i zaburzenia motoryki antrum żołądka⁵¹
Zakłócenie i nadwrażliwość dróg bólowych łączących mózg i żołądek⁵²

Niektórzy badacze proponują zmianę nazwy zespołu na „zespół bólu brzucha z powodu ucisku zwoju trzewnego” (NCGAPS – Nutcracker Celiac Ganglion Abdominal Pain Syndrome), aby lepiej odzwierciedlić neurogeniczny mechanizm bólu.⁵³⁵⁴⁵⁵

Czynniki ryzyka i epidemiologia

Ze względu na niejasną etiologię MALS, czynniki ryzyka nie są w pełni określone. Jednak badania wykazują pewne predyspozycje do wystąpienia tego zespołu:⁵⁶⁵⁷

Charakterystyka demograficzna

MALS występuje częściej u kobiet niż u mężczyzn⁵⁸⁵⁹
Najczęściej dotyka kobiety w wieku 20-40 lat, szczególnie o szczupłej budowie ciała⁶⁰⁶¹⁶²
Występuje częściej u dorosłych niż u dzieci, choć obserwowano przypadki u dzieci⁶³⁶⁴

Czynniki predysponujące

Szczupła budowa ciała lub niski procent tkanki tłuszczowej⁶⁵
Szybka utrata masy ciała⁶⁶⁶⁷⁶⁸
Zaburzenia tkanki łącznej, takie jak zespół Marfana, zespół Ehlersa-Danlosa⁶⁹
Dysplazja włóknisto-mięśniowa⁷⁰⁷¹
Przebyte operacje jamy brzusznej lub kręgosłupa⁷²⁷³
Uraz tępy jamy brzusznej⁷⁴⁷⁵

Epidemiologia

Zespół więzadła łukowatego środkowego jest schorzeniem rzadkim:⁷⁶⁷⁷

Występuje u około 0,002% populacji⁷⁸
Radiologiczne cechy ucisku tętnicy trzewnej przez więzadło łukowate środkowe występują u około 10-25% populacji⁷⁹⁸⁰
Tylko 1% osób z kompresją tętnicy trzewnej rozwija objawy kliniczne⁸¹⁸²
W Stanach Zjednoczonych rocznie diagnozuje się i leczy kilka tysięcy przypadków⁸³

Mechanizmy patofizjologiczne i konsekwencje kliniczne

Ucisk tętnicy trzewnej i splotu trzewnego przez więzadło łukowate środkowe prowadzi do szeregu następstw, które mogą wyjaśniać objawy kliniczne obserwowane u pacjentów z MALS:⁸⁴⁸⁵

Konsekwencje naczyniowe

Przewlekły ucisk tętnicy trzewnej może prowadzić do:⁸⁶⁸⁷

Zmian w przepływie krwi, które nasilają się podczas wydechu a zmniejszają podczas wdechu⁸⁸⁸⁹
Hiperplazji błony wewnętrznej tętnicy trzewnej⁹⁰
Zwężenia światła tętnicy i poszerzenia postenotycznego⁹¹⁹²
Charakterystycznego haczkowatego kształtu tętnicy trzewnej, widocznego w badaniach obrazowych⁹³⁹⁴
Tworzenia się tętniaków w obrębie naczyń trzewnych, szczególnie w łuku tętnicy trzustkowo-dwunastniczej⁹⁵⁹⁶

Konsekwencje neurologiczne

Ucisk splotu trzewnego i zwoju trzewnego może powodować:⁹⁷⁹⁸

Podrażnienie nerwów trzewnych⁹⁹
Skurcz naczyń trzewnych¹⁰⁰¹⁰¹
Zaburzenia aktywności elektrycznej żołądka¹⁰²
Upośledzenie motoryki antralnej żołądka¹⁰³
Szeroki zakres bólu brzucha, obejmujący sploty wątrobowe, żołądkowe, śledzionowe i trzustkowe¹⁰⁴

Związek z innymi schorzeniami

MALS może być powiązany z innymi schorzeniami:¹⁰⁵¹⁰⁶

Gastropareza – MALS może przyczyniać się do rozwoju gastroparezy lub jej nasilenia¹⁰⁷¹⁰⁸
Zaburzenia psychiatryczne – u pacjentów z MALS często występują objawy lękowe i depresyjne, które mogą utrzymywać się nawet po skutecznym leczeniu chirurgicznym¹⁰⁹
Zaburzenia funkcjonowania układu pokarmowego – sitofobia (lęk przed jedzeniem), znaczna utrata masy ciała, zaparcia i biegunka¹¹⁰
Dolegliwości bólowe niereagujące na standardowe leczenie przeciwbólowe¹¹¹

MALS może również być związany z innymi rzadkimi zaburzeniami naczyniowymi, takimi jak samoistne rozwarstwienie tętnicy trzewnej, zwłaszcza u pacjentów z zaburzeniami tkanki łącznej.¹¹²¹¹³

Szczególne przypadki i warianty etiologiczne

W literaturze medycznej opisano szczególne przypadki i warianty zespołu więzadła łukowatego środkowego, które mogą pomóc w lepszym zrozumieniu etiologii tego schorzenia:¹¹⁴¹¹⁵

MALS związany z urazem

Zespół więzadła łukowatego środkowego może rozwinąć się w następstwie urazu:¹¹⁶¹¹⁷

Tępy uraz jamy brzusznej może prowadzić do obrzęku i zmian w anatomii lokalnej¹¹⁸
Operacje trzustki, szczególnie pankreatoduodenektomia, mogą powodować zmiany w lokalnej anatomii i tkance łącznej¹¹⁹
Urazy kręgosłupa lub operacje kręgosłupa mogą zmieniać pozycję przepony i więzadła łukowatego środkowego¹²⁰

MALS w kontekście zaburzeń tkanki łącznej

U niektórych pacjentów MALS występuje w połączeniu z zaburzeniami tkanki łącznej:¹²¹¹²²

Zespół Marfana – zaburzenie genetyczne wpływające na tkankę łączną¹²³
Zespół Ehlersa-Danlosa – grupa zaburzeń dziedzicznych wpływających na kolagen¹²⁴
Warianty genu fibryliny-1 – mogą predysponować do arteriopatii i rozwarstwień tętnic trzewnych¹²⁵

MALS i konsekwencje naczyniowe

Przewlekły ucisk tętnicy trzewnej może prowadzić do poważnych następstw naczyniowych:¹²⁶¹²⁷

Tętniaki tętnic trzustkowo-dwunastniczych – występują u 68-74% pacjentów ze zwężeniem początkowego odcinka tętnicy trzewnej¹²⁸
Zawał śledziony – rzadkie powikłanie MALS wynikające ze zmniejszonego przepływu krwi w tętnicy śledzionowej¹²⁹
Rozwarstwienie tętnicy trzewnej – może występować w połączeniu z MALS, szczególnie u pacjentów z predyspozycjami genetycznymi¹³⁰¹³¹

MALS u dzieci

Zespół więzadła łukowatego środkowego obserwowano również u dzieci, co wskazuje na możliwe wrodzone podłoże tego schorzenia:¹³²¹³³

Przypadki MALS opisywano u dzieci, w tym u bliźniąt jednojajowych¹³⁴¹³⁵
U młodszych pacjentów MALS może stanowić wyzwanie diagnostyczne, gdyż objawy mogą być mniej charakterystyczne¹³⁶
Występowanie MALS u dzieci sugeruje możliwy wpływ czynników genetycznych na rozwój tego zespołu¹³⁷

Wystąpienie zespołu więzadła łukowatego środkowego we wczesnym wieku lub u rodzeństwa wskazuje na istotny udział czynników wrodzonych w etiologii tego schorzenia.¹³⁸

Wyzwania diagnostyczne i implikacje kliniczne

Diagnostyka zespołu więzadła łukowatego środkowego stanowi wyzwanie ze względu na niespecyficzne objawy i brak jednolitych kryteriów diagnostycznych:¹³⁹¹⁴⁰¹⁴¹

Diagnoza przez wykluczenie

MALS jest diagnozą z wykluczenia, co oznacza, że należy najpierw wykluczyć inne, częstsze przyczyny bólu brzucha:¹⁴²¹⁴³¹⁴⁴

Choroba wrzodowa żołądka i dwunastnicy¹⁴⁵
Choroby pęcherzyka żółciowego¹⁴⁶
Zapalenie wyrostka robaczkowego¹⁴⁷
Choroby zapalne jelit¹⁴⁸
Patologie wątroby i dróg żółciowych¹⁴⁹
Refluks żołądkowo-przełykowy i zapalenie żołądka¹⁵⁰
Choroba Leśniowskiego-Crohna¹⁵¹

Znaczenie diagnostyki obrazowej

Kluczową rolę w diagnostyce MALS odgrywają badania obrazowe:¹⁵²¹⁵³¹⁵⁴

Badanie USG metodą Dopplera – pozwala na ocenę przepływu krwi w tętnicy trzewnej, w tym zmian przepływu podczas wdechu i wydechu¹⁵⁵¹⁵⁶¹⁵⁷
Angiografia TK lub MR – umożliwia wizualizację charakterystycznego haczkowatego kształtu tętnicy trzewnej¹⁵⁸¹⁵⁹
Konwencjonalna angiografia naczyniowa – historycznie była metodą z wyboru, obecnie rzadziej stosowana¹⁶⁰

Główne znaleziska radiologiczne specyficzne dla MALS to: ucisk tętnicy trzewnej ze zmianami oddechowymi, poszerzenie postenotyczne oraz zwiększona prędkość przepływu krwi.¹⁶¹

Blok splotu trzewnego jako test diagnostyczny

Blok splotu trzewnego może służyć nie tylko jako opcja terapeutyczna, ale również jako test diagnostyczny:¹⁶²¹⁶³

Ustąpienie bólu po blokadzie splotu trzewnego może potwierdzić neurogeniczne podłoże objawów¹⁶⁴
Brak poprawy po blokadzie może wskazywać na inne przyczyny bólu brzucha¹⁶⁵

Multidyscyplinarne podejście do leczenia

Ze względu na złożoną etiologię MALS, leczenie wymaga podejścia multidyscyplinarnego:¹⁶⁶

Chirurdzy naczyniowi – odpowiedzialni za dekompresję tętnicy trzewnej¹⁶⁷
Chirurdzy ogólni – mogą uczestniczyć w laparoskopowym uwolnieniu więzadła¹⁶⁸
Specjaliści leczenia bólu – mogą wykonywać blokady splotu trzewnego¹⁶⁹
Radiolodzy interwencyjni – mogą przeprowadzać procedury rewaskularyzacyjne¹⁷⁰¹⁷¹
Psycholodzy/psychiatrzy – wsparcie dla pacjentów z towarzyszącymi zaburzeniami lękowymi i depresyjnymi¹⁷²

Jedyną skuteczną metodą leczenia MALS jest chirurgiczne uwolnienie więzadła łukowatego środkowego (dekompresja), które może być wykonywane metodą otwartą, laparoskopową lub z wykorzystaniem robota.¹⁷³¹⁷⁴¹⁷⁵

Podsumowanie etiologii MALS

Zespół więzadła łukowatego środkowego (MALS) jest rzadkim schorzeniem o złożonej i nie w pełni poznanej etiologii. Główną przyczyną jest ucisk tętnicy trzewnej i splotu trzewnego przez więzadło łukowate środkowe, co może wynikać z nieprawidłowości anatomicznych, czynników wrodzonych lub nabytych.¹⁷⁶¹⁷⁷¹⁷⁸

Patofizjologia MALS obejmuje zarówno komponenty naczyniowe (niedokrwienne), jak i neurogeniczne, przy czym coraz więcej dowodów wskazuje na istotną rolę ucisku i podrażnienia splotu trzewnego w powstawaniu objawów.¹⁷⁹¹⁸⁰¹⁸¹

Zespół ten występuje częściej u kobiet, szczególnie młodych i szczupłych, a czynniki ryzyka obejmują m.in. szybką utratę masy ciała, zaburzenia tkanki łącznej oraz przebyte urazy lub operacje jamy brzusznej i kręgosłupa.¹⁸²¹⁸³¹⁸⁴

Diagnostyka MALS stanowi wyzwanie ze względu na niespecyficzne objawy i brak jednolitych kryteriów diagnostycznych. Jest to diagnoza z wykluczenia, wymagająca szczegółowej diagnostyki obrazowej i multidyscyplinarnego podejścia do leczenia.¹⁸⁵¹⁸⁶¹⁸⁷

Lepsze zrozumienie etiologii MALS jest kluczowe dla usprawnienia diagnostyki i optymalizacji leczenia pacjentów cierpiących na to rzadkie, ale potencjalnie wyniszczające schorzenie.¹⁸⁸¹⁸⁹

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Materiały źródłowe

#1 Median arcuate ligament syndrome (MALS) – Symptoms and causes – Mayo Clinic
https://www.mayoclinic.org/diseases-conditions/median-arcuate-ligament-syndrome-mals/symptoms-causes/syc-20505001
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. […] The exact cause of median arcuate ligament syndrome, also called MALS, is not known. […] Because the cause of MALS is poorly understood, the risk factors are unclear. Median arcuate ligament syndrome is more common in adults than in children. It also is more common among women than among men. […] Some people have developed median arcuate ligament syndrome after pancreatic surgery or blunt injury to the upper stomach area.
#2 Median Arcuate Ligament Syndrome (MALS)
https://med.uth.edu/cvs/patient-care/conditionsandprocedures/median-arcuate-ligament-syndrome-mals/
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 cause remains unknown but may be due to compression of the sensitive outer arterial wall layer by the muscle and ganglionic tissue, direct irritation or inflammation of sympathetic nerves, and possibly intermittent decrease in blood supply to the upper gastrointestinal tract.
#3 Median arcuate ligament syndrome – UpToDate
https://www.uptodate.com/contents/median-arcuate-ligament-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. […] The etiology and pathophysiology of MALS are incompletely understood but may be related to both ischemic and neuropathic mechanisms. […] A subset of patients (approximately 10 percent) has an abnormally positioned median arcuate ligament that appears to compress an otherwise normally positioned celiac artery. […] 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.
#4 Overview of Median Arcuate Ligament Syndrome: A Narrative Review
https://pmc.ncbi.nlm.nih.gov/articles/PMC10629207/
Median arcuate ligament syndrome (MALS) is a rare disorder caused primarily by compression of the celiac trunk by the median arcuate ligament (MAL). […] It is believed to be caused by the constriction of the celiac artery and the celiac plexus by the median arcuate ligament (MAL). […] While the reason for this anatomical malformation is unknown, it is believed that both hereditary and environmental factors likely play a role in the development of MALS. […] Due to this abnormal anatomical structure, the celiac artery and the celiac plexus are compressed by the MAL. […] This compression may result in hyperplasia of the intimal wall of the celiac artery, thus causing stenosis of its lumen and ultimately resulting in ischemia of the abdominal organs. […] The symptoms of MALS are believed to be due to the abnormally low insertion of the MAL, which occurs because of errors in embryological development.
#5 MALS (Median Arcuate Ligament Syndrome): Symptoms & Diagnosis
https://my.clevelandclinic.org/health/diseases/16635-median-arcuate-ligament-syndrome-mals
Median arcuate ligament syndrome (MALS) refers to a condition that happens when the median arcuate ligament in your chest presses against your celiac artery and nearby nerves (celiac plexus). […] Experts dont know the exact reason why it happens. Some researchers suggest people are born with a median arcuate ligament thats not in the right place. Another theory is MALS is a complication of abdominal or spinal surgery or abdominal trauma.
#6 Overview of Median Arcuate Ligament Syndrome: A Narrative Review
https://pmc.ncbi.nlm.nih.gov/articles/PMC10629207/
Median arcuate ligament syndrome (MALS) is a rare disorder caused primarily by compression of the celiac trunk by the median arcuate ligament (MAL). […] It is believed to be caused by the constriction of the celiac artery and the celiac plexus by the median arcuate ligament (MAL). […] While the reason for this anatomical malformation is unknown, it is believed that both hereditary and environmental factors likely play a role in the development of MALS. […] Due to this abnormal anatomical structure, the celiac artery and the celiac plexus are compressed by the MAL. […] This compression may result in hyperplasia of the intimal wall of the celiac artery, thus causing stenosis of its lumen and ultimately resulting in ischemia of the abdominal organs. […] The symptoms of MALS are believed to be due to the abnormally low insertion of the MAL, which occurs because of errors in embryological development.
#7 Celiac Artery Compression Syndrome – StatPearls – NCBI Bookshelf
https://www.ncbi.nlm.nih.gov/books/NBK470601/
Celiac artery compression syndrome is also known as Dunbar syndrome or median arcuate ligament syndrome. It is a rare condition characterized by recurrent abdominal pain that results from compression of the celiac artery. Compression is due to the presence of a fibrous band of the diaphragm known as the median arcuate ligament. […] The etiology of celiac artery compression syndrome is not fully understood. Uncertainty arises because the anatomic compression of the celiac artery by the median arcuate ligament can also be seen in asymptomatic patients. In other words, every patient with this anatomic compression does not develop symptoms. The median arcuate ligament is a fibrous band that connects the two medial borders of the diaphragmatic crura, usually near the level of the 12th thoracic or first lumbar vertebra. Compression of the celiac artery can occur in two anatomic situations: an abnormally cephalad origin of the celiac artery or an abnormally caudad insertion of the diaphragm. Congenital factors may influence the level of the insertion of the diaphragm or the origin of the celiac artery. This hypothesis is supported by a small series of studies in families and monozygotic twins. The compression of the celiac artery by the median arcuate ligament is believed to cause intermittent mesenteric ischemia. However, this explanation alone may not completely explain the condition as there is usually a rich collateral network of mesenteric vessels between the celiac artery and the superior mesenteric artery. Therefore, there may be a role for underlying celiac nerve plexus dysfunction as well when considering the etiology of this condition. Nerve dysfunction may lead to abnormal splanchnic vasoconstriction, leading to ischemia.
#8 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. […] The primary cause of MALS is the anatomical compression of the celiac artery by the median arcuate ligament. This fibrous band usually sits above the artery but can sometimes position itself lower than usual, pressing against the artery and surrounding nerves, such as the celiac plexus and celiac ganglion. […] Several factors can increase the risk of developing MALS, including: Rapid Weight Loss: Loss of the protective fat pad surrounding the artery can increase the likelihood of compression. Anatomical Variations: Individuals with specific anatomical configurations, like the median arcuate ligament muscle and fibers, are more prone to MALS. Demographics: MALS most commonly affects women, particularly those between the ages of 20 and 40. Conditions like Dunbar Syndrome may also be associated with MALS.
#9 Median Arcuate Ligament Syndrome (MALS) – The Operative Review Of Surgery
https://operativereview.com/median_arcuate_ligament_syndrome/
Median Arcuate Ligament Compresses Celiac Artery […] Causes: Abnormally High Origin of Celiac Artery (Most Common) […] Abnormally Low Median Arcuate Ligament (10%) […] Celiac Plexus Nerves Can Also Contribute to Compression.
#10 Celiac Artery Compression Syndrome – StatPearls – NCBI Bookshelf
https://www.ncbi.nlm.nih.gov/books/NBK470601/
Celiac artery compression syndrome is also known as Dunbar syndrome or median arcuate ligament syndrome. It is a rare condition characterized by recurrent abdominal pain that results from compression of the celiac artery. Compression is due to the presence of a fibrous band of the diaphragm known as the median arcuate ligament. […] The etiology of celiac artery compression syndrome is not fully understood. Uncertainty arises because the anatomic compression of the celiac artery by the median arcuate ligament can also be seen in asymptomatic patients. In other words, every patient with this anatomic compression does not develop symptoms. The median arcuate ligament is a fibrous band that connects the two medial borders of the diaphragmatic crura, usually near the level of the 12th thoracic or first lumbar vertebra. Compression of the celiac artery can occur in two anatomic situations: an abnormally cephalad origin of the celiac artery or an abnormally caudad insertion of the diaphragm. Congenital factors may influence the level of the insertion of the diaphragm or the origin of the celiac artery. This hypothesis is supported by a small series of studies in families and monozygotic twins. The compression of the celiac artery by the median arcuate ligament is believed to cause intermittent mesenteric ischemia. However, this explanation alone may not completely explain the condition as there is usually a rich collateral network of mesenteric vessels between the celiac artery and the superior mesenteric artery. Therefore, there may be a role for underlying celiac nerve plexus dysfunction as well when considering the etiology of this condition. Nerve dysfunction may lead to abnormal splanchnic vasoconstriction, leading to ischemia.
#11 Celiac Artery Compression Syndrome – StatPearls – NCBI Bookshelf
https://www.ncbi.nlm.nih.gov/books/NBK470601/
Celiac artery compression syndrome is also known as Dunbar syndrome or median arcuate ligament syndrome. It is a rare condition characterized by recurrent abdominal pain that results from compression of the celiac artery. Compression is due to the presence of a fibrous band of the diaphragm known as the median arcuate ligament. […] The etiology of celiac artery compression syndrome is not fully understood. Uncertainty arises because the anatomic compression of the celiac artery by the median arcuate ligament can also be seen in asymptomatic patients. In other words, every patient with this anatomic compression does not develop symptoms. The median arcuate ligament is a fibrous band that connects the two medial borders of the diaphragmatic crura, usually near the level of the 12th thoracic or first lumbar vertebra. Compression of the celiac artery can occur in two anatomic situations: an abnormally cephalad origin of the celiac artery or an abnormally caudad insertion of the diaphragm. Congenital factors may influence the level of the insertion of the diaphragm or the origin of the celiac artery. This hypothesis is supported by a small series of studies in families and monozygotic twins. The compression of the celiac artery by the median arcuate ligament is believed to cause intermittent mesenteric ischemia. However, this explanation alone may not completely explain the condition as there is usually a rich collateral network of mesenteric vessels between the celiac artery and the superior mesenteric artery. Therefore, there may be a role for underlying celiac nerve plexus dysfunction as well when considering the etiology of this condition. Nerve dysfunction may lead to abnormal splanchnic vasoconstriction, leading to ischemia.
#12 Median arcuate ligament syndrome: Incidental finding or real problem? | Cleveland Clinic Journal of Medicine
https://www.ccjm.org/content/88/3/140
Median arcuate ligament syndrome, 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. […] Theories regarding the pathophysiology of epigastric pain associated with MALS include foregut ischemia due to compressed celiac artery, midgut ischemia due to vascular steal syndrome, and overstimulation of the celiac plexus with subsequent splanchnic vasoconstriction and ischemia. Recently, ideas about the etiology of MALS have shifted from its being a vascular disease to a neurogenic disorder with compression of the surrounding celiac plexus and ganglion. […] Anatomically, up to 24% of the population may have compression of the celiac artery; however, fewer than 1% of them have symptoms.
#13 Median arcuate ligament syndrome – UpToDate
https://www.uptodate.com/contents/median-arcuate-ligament-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. […] The etiology and pathophysiology of MALS are incompletely understood but may be related to both ischemic and neuropathic mechanisms. […] A subset of patients (approximately 10 percent) has an abnormally positioned median arcuate ligament that appears to compress an otherwise normally positioned celiac artery. […] 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.
#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. […] Median arcuate ligament syndrome (MALS) refers to the external compression of the coeliac plexus by the median arcuate ligament (MAL) with resulting symptoms. […] Compression alone is a common radiological finding in approximately 25% of the population; however, only 1% of the population have corresponding symptoms. […] Chronic compression by this ligament can lead to hyperplastic intimal changes of the coeliac artery. […] This might progress to cause stenosis or complete arterial occlusion, along with post-stenotic dilation and coeliac artery aneurysms. […] The pathophysiology of MALS is unclear, and multiple theories have been discussed in the literature.
#15 Median Arcuate Ligament Syndrome – Practical Gastro
https://practicalgastro.com/2015/02/05/median-arcuate-ligament-syndrome/
Many theories have been proposed to explain this altered anatomy including congenital origin as it has been found in children and twins, as well as traumatic origin. The presentation in adults could be explained by a combination of a congenitally early take off origin of the celiac artery and/or an abnormally thickened MAL with or without accompanying arteriosclerosis in the vessel that may predispose to the narrowing finding on expiration.
#16
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. […] The location of the median arcuate ligament and celiac artery varies slightly from person to person. Typically, the ligament runs across the largest blood vessel in the body (aorta). It sits above the celiac artery. But sometimes the ligament or artery may be out of place, causing MALS. The ligament may also put pressure on the network of nerves surrounding the celiac artery (celiac plexus). […] Doctors aren’t exactly sure what causes median arcuate ligament syndrome. The causes and diagnosis of MALS are a subject of controversy. […] Because the cause of MALS is poorly understood, the risk factors for the syndrome are unclear. MALS has been seen in children, even twins, which might mean genetics plays a role. […] Some people have developed MALS after pancreatic surgery and blunt injury to the upper stomach area.
#17 Celiac Artery Compression Syndrome – StatPearls – NCBI Bookshelf
https://www.ncbi.nlm.nih.gov/books/NBK470601/
Celiac artery compression syndrome is also known as Dunbar syndrome or median arcuate ligament syndrome. It is a rare condition characterized by recurrent abdominal pain that results from compression of the celiac artery. Compression is due to the presence of a fibrous band of the diaphragm known as the median arcuate ligament. […] The etiology of celiac artery compression syndrome is not fully understood. Uncertainty arises because the anatomic compression of the celiac artery by the median arcuate ligament can also be seen in asymptomatic patients. In other words, every patient with this anatomic compression does not develop symptoms. The median arcuate ligament is a fibrous band that connects the two medial borders of the diaphragmatic crura, usually near the level of the 12th thoracic or first lumbar vertebra. Compression of the celiac artery can occur in two anatomic situations: an abnormally cephalad origin of the celiac artery or an abnormally caudad insertion of the diaphragm. Congenital factors may influence the level of the insertion of the diaphragm or the origin of the celiac artery. This hypothesis is supported by a small series of studies in families and monozygotic twins. The compression of the celiac artery by the median arcuate ligament is believed to cause intermittent mesenteric ischemia. However, this explanation alone may not completely explain the condition as there is usually a rich collateral network of mesenteric vessels between the celiac artery and the superior mesenteric artery. Therefore, there may be a role for underlying celiac nerve plexus dysfunction as well when considering the etiology of this condition. Nerve dysfunction may lead to abnormal splanchnic vasoconstriction, leading to ischemia.
#18 Median arcuate ligament syndrome (MALS) – Hancock Health
https://www.hancockhealth.org/ja/mayo-health-library/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. […] The exact cause of median arcuate ligament syndrome, also called MALS, is not known. […] Because the cause of MALS is poorly understood, the risk factors are unclear. Median arcuate ligament syndrome is more common in adults than in children. It also is more common among women than among men. […] MALS also has been seen in identical twins, so genetics may play a role. […] Some people have developed median arcuate ligament syndrome after pancreatic surgery or blunt injury to the upper stomach area.
#19 Overview of Median Arcuate Ligament Syndrome: A Narrative Review
https://pmc.ncbi.nlm.nih.gov/articles/PMC10629207/
Median arcuate ligament syndrome (MALS) is a rare disorder caused primarily by compression of the celiac trunk by the median arcuate ligament (MAL). […] It is believed to be caused by the constriction of the celiac artery and the celiac plexus by the median arcuate ligament (MAL). […] While the reason for this anatomical malformation is unknown, it is believed that both hereditary and environmental factors likely play a role in the development of MALS. […] Due to this abnormal anatomical structure, the celiac artery and the celiac plexus are compressed by the MAL. […] This compression may result in hyperplasia of the intimal wall of the celiac artery, thus causing stenosis of its lumen and ultimately resulting in ischemia of the abdominal organs. […] The symptoms of MALS are believed to be due to the abnormally low insertion of the MAL, which occurs because of errors in embryological development.
#20 Overview of Median Arcuate Ligament Syndrome: A Narrative Review
https://pmc.ncbi.nlm.nih.gov/articles/PMC10629207/
Median arcuate ligament syndrome (MALS) is a rare disorder caused primarily by compression of the celiac trunk by the median arcuate ligament (MAL). […] It is believed to be caused by the constriction of the celiac artery and the celiac plexus by the median arcuate ligament (MAL). […] While the reason for this anatomical malformation is unknown, it is believed that both hereditary and environmental factors likely play a role in the development of MALS. […] Due to this abnormal anatomical structure, the celiac artery and the celiac plexus are compressed by the MAL. […] This compression may result in hyperplasia of the intimal wall of the celiac artery, thus causing stenosis of its lumen and ultimately resulting in ischemia of the abdominal organs. […] The symptoms of MALS are believed to be due to the abnormally low insertion of the MAL, which occurs because of errors in embryological development.
#21 What is Median Arcuate Ligament Syndrome (MALS)? — Accountability Muse
https://www.accountabilitymuse.com/blog/what-is-median-arcuate-ligament-syndrome-mals
„It can also be developmental. So for example, with growth spurts, connective tissue disorders and lordosis.” […] „The other thing that can happen is just an alteration of anatomy, either from abdominal or spinal surgery or abdominal trauma.” […] „Median Arcuate Ligament Syndrome (MALS) is a rare entity characterized by severe post-prandial epigastric pain, nausea, vomiting, and/or weight loss.” […] „Symptoms have been attributed to vascular compression (celiac artery compression syndrome, CACS), but it remains controversial whether they could be secondary to neural compression.” […] „Our findings support neurogenic compression as a contributing factor in the development of pain and other MALS symptoms, and favor the use of MALS rather than CACS as diagnostic terminology.” […] „It is notable that these conditions are more prevalent in the MALS population than in the general population, suggesting a possible pathophysiologic relationship.”
#22
https://www.tropicalgastro.com/articles/41/1/Median-Arcuate-Ligament-Syndrome-Rare-Cause-of-Post-Prandial-Abdominal-Pain.html
Median arcuate ligament syndrome (MALS) is a condition characterized by chronic, recurrent abdominal pain due to compression of the celiac artery by the median arcuate ligament of the diaphragm. […] The postulated mechanisms of MALS are both ischemic and neuropathic. Compression of the celiac artery occurs due to the abnormally low-lying ligament. […] An acquired transient form of the syndrome has also been reported following blunt abdominal trauma and pancreatic surgical procedures, such as pancreaticoduodenectomy; likely related to the local trauma and resultant edema. […] A definitive diagnosis of MALS requires vascular imaging to confirm compression of the celiac artery by the median arcuate ligament (duplex ultrasound combined with advanced vascular imaging), preferably with respiratory maneuvers.
#23 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. MALS is caused when the ligament descends lower or the celiac artery is anatomically positioned higher on the Aorta causing the ligament to cross over and compress the celiac artery and surrounding tissue which can include the celiac plexus nerves. As of right now there are multiple theories of why MALS occurs within the body. Some of those theories are that this structural anomaly could be congenital, meaning from birth or develop after spinal surgery, abdominal surgery or due to abdominal trauma. […] Compromised blood flow and inflammation results in changes in oxygen levels (hypoxia/HIF factor and oxidative stress) and nutrients to the abdominal organs and nerves which can result in consequential damage.
#24 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. […] The primary cause of MALS is the anatomical compression of the celiac artery by the median arcuate ligament. This fibrous band usually sits above the artery but can sometimes position itself lower than usual, pressing against the artery and surrounding nerves, such as the celiac plexus and celiac ganglion. […] Several factors can increase the risk of developing MALS, including: Rapid Weight Loss: Loss of the protective fat pad surrounding the artery can increase the likelihood of compression. Anatomical Variations: Individuals with specific anatomical configurations, like the median arcuate ligament muscle and fibers, are more prone to MALS. Demographics: MALS most commonly affects women, particularly those between the ages of 20 and 40. Conditions like Dunbar Syndrome may also be associated with MALS.
#25 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. […] Severe stenosis of the celiac artery is predicted to affect 1% of patients with imaging findings of MALS. […] Recognition of MALS as a potential etiology in the diagnostic evaluation of abdominal pain is of growing clinical importance. […] Increased bariatric surgery incidence leads to a higher prevalence of patients with rapid weight loss: a major risk factor for the development of MALS. […] The celiac nerve plexus impingement in MALS can lead to a broad distribution of abdominal pain, such as further hepatic, gastric, splenic, and pancreatic plexuses. […] However, challenges in diagnosis include the nonspecific symptoms seen in the triad commonly associated with MALS: epigastric pain, weight loss, and abdominal bruit. […] Doppler vascular ultrasound to evaluate respiratory variation can help determine if compression is clinically significant and may be contributing to abdominal pain.
#26 Median arcuate ligament syndrome (MALS) – Symptoms and causes – Mayo Clinic
https://www.mayoclinic.org/diseases-conditions/median-arcuate-ligament-syndrome-mals/symptoms-causes/syc-20505001
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. […] The exact cause of median arcuate ligament syndrome, also called MALS, is not known. […] Because the cause of MALS is poorly understood, the risk factors are unclear. Median arcuate ligament syndrome is more common in adults than in children. It also is more common among women than among men. […] Some people have developed median arcuate ligament syndrome after pancreatic surgery or blunt injury to the upper stomach area.
#27 Median arcuate ligament syndrome (MALS) | Health Library | Memorial Health System
https://www.mhsystem.org/health-library/con-20459603/
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. […] But sometimes, the ligament or arteries may be out of place. The ligament may put pressure on the celiac artery and the network of surrounding nerves, called the celiac plexus. This pressure can cause the symptoms of MALS. The condition can cause serious stomach pain in some people. […] The exact cause of median arcuate ligament syndrome, also called MALS, is not known. […] Because the cause of MALS is poorly understood, the risk factors are unclear. Median arcuate ligament syndrome is more common in adults than in children. It also is more common among women than among men. […] Some people have developed median arcuate ligament syndrome after pancreatic surgery or blunt injury to the upper stomach area.
#28 Mayo Clinic Health Library – Median arcuate ligament syndrome (MALS) | Swiss Medical Network
https://www.swissmedical.net/en/healtcare-library/con-20459603
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. […] The exact cause of median arcuate ligament syndrome, also called MALS, is not known. […] Because the cause of MALS is poorly understood, the risk factors are unclear. Median arcuate ligament syndrome is more common in adults than in children. It also is more common among women than among men. […] Some people have developed median arcuate ligament syndrome after pancreatic surgery or blunt injury to the upper stomach area.
#29 Median arcuate ligament syndrome (MALS) – Vejthani Hospital | JCI Accredited International Hospital in Bangkok, Thailand.
https://www.vejthani.com/diseases-conditions/median-arcuate-ligament-syndrome-mals/
Median arcuate ligament syndrome (MALS) develops when the artery that supplies blood to the upper abdomen is compressed by the arc-shaped band of tissue in the chest region. […] The actual cause of median arcuate ligament syndrome is unknown to medical professionals. There is debate concerning the origins and diagnosis of MALS. […] The risk factors for MALS are uncertain because it is unclear what causes the illness. MALS has been observed in children, including twins, suggesting that genetics may be involved. […] After pancreatic surgery and a traumatic blunt abdominal injury, some patients experienced MALS.
#30 MALS (Median Arcuate Ligament Syndrome): Symptoms & Diagnosis
https://my.clevelandclinic.org/health/diseases/16635-median-arcuate-ligament-syndrome-mals
Median arcuate ligament syndrome (MALS) refers to a condition that happens when the median arcuate ligament in your chest presses against your celiac artery and nearby nerves (celiac plexus). […] Experts dont know the exact reason why it happens. Some researchers suggest people are born with a median arcuate ligament thats not in the right place. Another theory is MALS is a complication of abdominal or spinal surgery or abdominal trauma.
#31 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. MALS is caused when the ligament descends lower or the celiac artery is anatomically positioned higher on the Aorta causing the ligament to cross over and compress the celiac artery and surrounding tissue which can include the celiac plexus nerves. As of right now there are multiple theories of why MALS occurs within the body. Some of those theories are that this structural anomaly could be congenital, meaning from birth or develop after spinal surgery, abdominal surgery or due to abdominal trauma. […] Compromised blood flow and inflammation results in changes in oxygen levels (hypoxia/HIF factor and oxidative stress) and nutrients to the abdominal organs and nerves which can result in consequential damage.
#32 Median Arcuate Ligament Syndrome – Practical Gastro
https://practicalgastro.com/2015/02/05/median-arcuate-ligament-syndrome/
Many theories have been proposed to explain this altered anatomy including congenital origin as it has been found in children and twins, as well as traumatic origin. The presentation in adults could be explained by a combination of a congenitally early take off origin of the celiac artery and/or an abnormally thickened MAL with or without accompanying arteriosclerosis in the vessel that may predispose to the narrowing finding on expiration.
#33 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. […] Median arcuate ligament syndrome (MALS) refers to the external compression of the coeliac plexus by the median arcuate ligament (MAL) with resulting symptoms. […] Compression alone is a common radiological finding in approximately 25% of the population; however, only 1% of the population have corresponding symptoms. […] Chronic compression by this ligament can lead to hyperplastic intimal changes of the coeliac artery. […] This might progress to cause stenosis or complete arterial occlusion, along with post-stenotic dilation and coeliac artery aneurysms. […] The pathophysiology of MALS is unclear, and multiple theories have been discussed in the literature.
#34 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
It is thought that the compression of the coeliac artery can cause foregut pain and ischaemia during increased demand when patients eat. […] Some postulate that a steal phenomenon occurs due to significant collateral circulation causing blood to be diverted away from the midgut to the foregut following meals, resulting in midgut ischaemia and pain. […] Further theories include that overstimulation of the coeliac plexus causes significant vasoconstriction, which results in ischaemic abdominal pain and the entrapment of the coeliac ganglion, altering gastric myoelectrical activity, impairing antral motility and causing neurogenic pain. […] The prevalence of MALS remains unclear, which is partly due to its variable clinical presentation. […] MALS occurs most commonly in young women. […] MALS does not have universally accepted diagnostic criteria.
#35 Median arcuate ligament syndrome: Incidental finding or real problem? | Cleveland Clinic Journal of Medicine
https://www.ccjm.org/content/88/3/140
Median arcuate ligament syndrome, 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. […] Theories regarding the pathophysiology of epigastric pain associated with MALS include foregut ischemia due to compressed celiac artery, midgut ischemia due to vascular steal syndrome, and overstimulation of the celiac plexus with subsequent splanchnic vasoconstriction and ischemia. Recently, ideas about the etiology of MALS have shifted from its being a vascular disease to a neurogenic disorder with compression of the surrounding celiac plexus and ganglion. […] Anatomically, up to 24% of the population may have compression of the celiac artery; however, fewer than 1% of them have symptoms.
#36 Overview of Median Arcuate Ligament Syndrome: A Narrative Review
https://pmc.ncbi.nlm.nih.gov/articles/PMC10629207/
Median arcuate ligament syndrome (MALS) is a rare disorder caused primarily by compression of the celiac trunk by the median arcuate ligament (MAL). […] It is believed to be caused by the constriction of the celiac artery and the celiac plexus by the median arcuate ligament (MAL). […] While the reason for this anatomical malformation is unknown, it is believed that both hereditary and environmental factors likely play a role in the development of MALS. […] Due to this abnormal anatomical structure, the celiac artery and the celiac plexus are compressed by the MAL. […] This compression may result in hyperplasia of the intimal wall of the celiac artery, thus causing stenosis of its lumen and ultimately resulting in ischemia of the abdominal organs. […] The symptoms of MALS are believed to be due to the abnormally low insertion of the MAL, which occurs because of errors in embryological development.
#37 Median Arcuate Ligament Syndrome (MALS)
https://med.uth.edu/cvs/patient-care/conditionsandprocedures/median-arcuate-ligament-syndrome-mals/
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 cause remains unknown but may be due to compression of the sensitive outer arterial wall layer by the muscle and ganglionic tissue, direct irritation or inflammation of sympathetic nerves, and possibly intermittent decrease in blood supply to the upper gastrointestinal tract.
#38 Median Arcuate Ligament Syndrome (MALS): Symptoms and Treatment – UChicago Medicine
https://www.uchicagomedicine.org/conditions-services/heart-vascular/vascular-disease/median-arcuate-ligament-syndrome
Median Arcuate Ligament Syndrome (MALS disease) occurs when the celiac artery (the artery below that diaphragm that stems from the aorta) becomes compressed by the median arcuate ligament. […] When the median arcuate ligament is restricted, the blood flow is limited to the digestive system which can ultimately lead to significant abdominal pain.
#39 Overview of Median Arcuate Ligament Syndrome: A Narrative Review
https://pmc.ncbi.nlm.nih.gov/articles/PMC10629207/
Median arcuate ligament syndrome (MALS) is a rare disorder caused primarily by compression of the celiac trunk by the median arcuate ligament (MAL). […] It is believed to be caused by the constriction of the celiac artery and the celiac plexus by the median arcuate ligament (MAL). […] While the reason for this anatomical malformation is unknown, it is believed that both hereditary and environmental factors likely play a role in the development of MALS. […] Due to this abnormal anatomical structure, the celiac artery and the celiac plexus are compressed by the MAL. […] This compression may result in hyperplasia of the intimal wall of the celiac artery, thus causing stenosis of its lumen and ultimately resulting in ischemia of the abdominal organs. […] The symptoms of MALS are believed to be due to the abnormally low insertion of the MAL, which occurs because of errors in embryological development.
#40 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. […] Median arcuate ligament syndrome (MALS) refers to the external compression of the coeliac plexus by the median arcuate ligament (MAL) with resulting symptoms. […] Compression alone is a common radiological finding in approximately 25% of the population; however, only 1% of the population have corresponding symptoms. […] Chronic compression by this ligament can lead to hyperplastic intimal changes of the coeliac artery. […] This might progress to cause stenosis or complete arterial occlusion, along with post-stenotic dilation and coeliac artery aneurysms. […] The pathophysiology of MALS is unclear, and multiple theories have been discussed in the literature.
#41 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
It is thought that the compression of the coeliac artery can cause foregut pain and ischaemia during increased demand when patients eat. […] Some postulate that a steal phenomenon occurs due to significant collateral circulation causing blood to be diverted away from the midgut to the foregut following meals, resulting in midgut ischaemia and pain. […] Further theories include that overstimulation of the coeliac plexus causes significant vasoconstriction, which results in ischaemic abdominal pain and the entrapment of the coeliac ganglion, altering gastric myoelectrical activity, impairing antral motility and causing neurogenic pain. […] The prevalence of MALS remains unclear, which is partly due to its variable clinical presentation. […] MALS occurs most commonly in young women. […] MALS does not have universally accepted diagnostic criteria.
#42 Median arcuate ligament syndrome (Dunbar syndrome) – Iqbal – Cardiovascular Diagnosis and Therapy
https://cdt.amegroups.org/article/view/67298/html
Median arcuate ligament syndrome (MALS) is a rare condition which is due to the compression of celiac trunk by low riding of fibrous attachments of median arcuate ligament and diaphragmatic crura. […] The higher origin of celiac artery or lower insertion of diaphragmatic crura are likely to lead to MALS. […] Sometimes median arcuate ligament crosses the lower abdominal aorta causing compression. […] Compression can be due to thick, fibrous tissue or thin bands at or near the origin of celiac artery. […] The treatment of MALS aims at decompression of celiac artery to establish adequate blood flow and pain management by neurolysis. […] The neuropathic pain of MALS can be addressed with removal or ablation of ganglion and celiac artery revascularization. […] The role of intervention radiology is emerging in the treatment of MALS, though its outcomes are not promising. […] This may be due to the extrinsic compression of celiac artery causing intimal hyperplasia resulting luminal narrowing of artery. […] However, further definitive studies are needed to address the pathophysiology, better diagnose and devise minimally invasive treatment for this entity.
#43 Median arcuate ligament syndrome – Wikipedia
https://en.wikipedia.org/wiki/Median_arcuate_ligament_syndrome
The hook-shaped contour of the celiac artery is characteristic of the anatomy in MALS and helps distinguish it from other causes of celiac artery stenosis such as atherosclerosis. […] Decompression of the celiac artery is the general approach to treatment of MALS. […] The syndrome most commonly affects individuals between 20 and 40 years old, and is more common in women, particularly thin women.
#44 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
It is thought that the compression of the coeliac artery can cause foregut pain and ischaemia during increased demand when patients eat. […] Some postulate that a steal phenomenon occurs due to significant collateral circulation causing blood to be diverted away from the midgut to the foregut following meals, resulting in midgut ischaemia and pain. […] Further theories include that overstimulation of the coeliac plexus causes significant vasoconstriction, which results in ischaemic abdominal pain and the entrapment of the coeliac ganglion, altering gastric myoelectrical activity, impairing antral motility and causing neurogenic pain. […] The prevalence of MALS remains unclear, which is partly due to its variable clinical presentation. […] MALS occurs most commonly in young women. […] MALS does not have universally accepted diagnostic criteria.
#45 A Median Arcuate Ligament Syndrome Could Be Re-termed as a Nutcracker Celiac Ganglion Abdominal Pain Syndrome
https://www.jnmjournal.org/journal/view.html?volume=29&number=2&spage=200
Median arcuate ligament syndrome (MALS) is known as chronic recurrent abdominal pain related to compression of the celiac artery by the median arcuate ligament. […] Two hypotheses of MALS etiology are well known, one due to the decrease in intravascular blood flow due to compression of the celiac artery as the pathogenesis, and the other due to overestimation by the celiac ganglion. […] The mechanism of MALS is unclear and it is not included in the diagnostic category for abdominal pain, some case reports of MALS have been described with rare congenital diseases or gastroparesis. […] We suggest renaming MALS as NCGAPS, nutcracker celiac ganglion abdominal pain syndrome, to better explain the mechanism of the recurrent abdominal pain. […] If the mechanism of abdominal pain in MALS is decrease in blood flow due to celiac artery compression, there should be evidence of ischemic tissue damage, but we could not find any ischemic evidence in the liver or stomach in our patients according to liver function profiles, CT, or endoscopy.
#46 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. […] Because the median arcuate ligament is compressing both the celiac artery and the celiac ganglion nerves, there is debate as to whether the cause of pain is ischemic (caused by blood flow) or neurogenic (caused by the nerves). […] Many doctors believe MALS is a vascular issue however, this does not explain the pain patients feel, nor does it address those patients who continue to suffer despite having adequate blood flow through the celiac artery. […] Those who believe MALS is a neurologic issue focus on the celiac ganglion as the main cause of a patients symptoms. Because of the pressure on the nerves, they have become inflamed beyond the point of repair. These inflamed nerves must be addressed to resolve the patients disabling pain.
#47 Median Arcuate Ligament Syndrome – Practical Gastro
https://practicalgastro.com/2015/02/05/median-arcuate-ligament-syndrome/
Median arcuate ligament syndrome (MALS), also known as celiac artery compression syndrome (CACS), Dunbar syndrome and celiac axis syndrome is a cause of chronic epigastric and right upper quadrant abdominal pain that is explained by the median arcuate ligament, a fibrous tissue connecting the two crura of the diaphragm, compressing the celiac artery and its companion structure, the celiac ganglion. Theories explaining the pathophysiology of the disease suggest either neurogenic or vascular origin. […] It was first suggested that the compromise of blood supply by compression of the celiac artery would lead to post prandial ischemia and hence worse abdominal pain. However the SMA and IMA are widely patent in this entity and the stomach has extensive collateral blood flow from the gastric and epiploic arcades leading to the conclusion that ischemia is not the explanation for the abdominal pain and other associated symptoms. It was suggested later that pressure on the celiac plexus might be the main etiological factor in MALS and thus it could also explain the accompanying findings often present in addition to the abdominal pain, namely nausea, vomiting, gastroparesis, and gastric electrical dysrhythmias.
#48 MALS (Median Arcuate Ligament Syndrome): Symptoms & Care
https://revascular.co.nz/mals-median-arcuate-ligament-syndrome/
MALS is a condition where a diaphragm ligament (median arcuate ligament) narrows the main artery to the stomach, liver, spleen and pancreas. This is called the coeliac artery. […] The diaphragm is a muscle that is important for breathing. Where it joins the spine at the back of the stomach, there is a tough ligament called the median arcuate ligament. The main artery to the stomach passes through this area and can be narrowed by this ligament. […] Pressure on these nerves from the ligament will likely be another important factor in the pain caused by MALS.
#49 Median arcuate ligament syndrome: Incidental finding or real problem? | Cleveland Clinic Journal of Medicine
https://www.ccjm.org/content/88/3/140
Median arcuate ligament syndrome, 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. […] Theories regarding the pathophysiology of epigastric pain associated with MALS include foregut ischemia due to compressed celiac artery, midgut ischemia due to vascular steal syndrome, and overstimulation of the celiac plexus with subsequent splanchnic vasoconstriction and ischemia. Recently, ideas about the etiology of MALS have shifted from its being a vascular disease to a neurogenic disorder with compression of the surrounding celiac plexus and ganglion. […] Anatomically, up to 24% of the population may have compression of the celiac artery; however, fewer than 1% of them have symptoms.
#50 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
It is thought that the compression of the coeliac artery can cause foregut pain and ischaemia during increased demand when patients eat. […] Some postulate that a steal phenomenon occurs due to significant collateral circulation causing blood to be diverted away from the midgut to the foregut following meals, resulting in midgut ischaemia and pain. […] Further theories include that overstimulation of the coeliac plexus causes significant vasoconstriction, which results in ischaemic abdominal pain and the entrapment of the coeliac ganglion, altering gastric myoelectrical activity, impairing antral motility and causing neurogenic pain. […] The prevalence of MALS remains unclear, which is partly due to its variable clinical presentation. […] MALS occurs most commonly in young women. […] MALS does not have universally accepted diagnostic criteria.
#51 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
It is thought that the compression of the coeliac artery can cause foregut pain and ischaemia during increased demand when patients eat. […] Some postulate that a steal phenomenon occurs due to significant collateral circulation causing blood to be diverted away from the midgut to the foregut following meals, resulting in midgut ischaemia and pain. […] Further theories include that overstimulation of the coeliac plexus causes significant vasoconstriction, which results in ischaemic abdominal pain and the entrapment of the coeliac ganglion, altering gastric myoelectrical activity, impairing antral motility and causing neurogenic pain. […] The prevalence of MALS remains unclear, which is partly due to its variable clinical presentation. […] MALS occurs most commonly in young women. […] MALS does not have universally accepted diagnostic criteria.
#52 MALS: Median Arcuate Ligament Syndrome Overview
https://www.verywellhealth.com/mals-median-arcuate-ligament-syndrome-4691027
One hypothesis is that these nerves are overstimulated in people with symptomatic MALS and that this leads to a spasm of the arteries that supply blood to the stomach and small bowel. In this theory, these spasms are believed to be the cause of abdominal pain. […] Yet another theory as to the cause of MALS is that the nerves in the area (the celiac plexus and peri-aortic ganglia) are actually compressed. This may interfere with and cause hypersensitivity in the pain pathways connecting the brain and stomach. […] It is likely that a combination of these factors results in the characteristic symptoms of MALS. […] MALS occurs when the median arcuate ligament compresses the celiac artery. It is unclear why this happens in some people. However, experts suspect vascular and neurologic components may cause it.
#53 A Median Arcuate Ligament Syndrome Could Be Re-termed as a Nutcracker Celiac Ganglion Abdominal Pain Syndrome
https://www.jnmjournal.org/journal/view.html?volume=29&number=2&spage=200
Median arcuate ligament syndrome (MALS) is known as chronic recurrent abdominal pain related to compression of the celiac artery by the median arcuate ligament. […] Two hypotheses of MALS etiology are well known, one due to the decrease in intravascular blood flow due to compression of the celiac artery as the pathogenesis, and the other due to overestimation by the celiac ganglion. […] The mechanism of MALS is unclear and it is not included in the diagnostic category for abdominal pain, some case reports of MALS have been described with rare congenital diseases or gastroparesis. […] We suggest renaming MALS as NCGAPS, nutcracker celiac ganglion abdominal pain syndrome, to better explain the mechanism of the recurrent abdominal pain. […] If the mechanism of abdominal pain in MALS is decrease in blood flow due to celiac artery compression, there should be evidence of ischemic tissue damage, but we could not find any ischemic evidence in the liver or stomach in our patients according to liver function profiles, CT, or endoscopy.
#54 A Median Arcuate Ligament Syndrome Could Be Re-termed as a Nutcracker Celiac Ganglion Abdominal Pain Syndrome
https://www.jnmjournal.org/journal/view.html?volume=29&number=2&spage=200
NCGAPS is overlooked as a cause of abdominal pain because it is still considered a very rare disease and the mechanism is unclear. […] Our study suggests a diagnostic process of abdominal pain of unknown etiology. First, exclude organic GI disease by abdomen and pelvis CT scan and esophagogastroduodenoscopy. After excluding the problem of organic GI disease, listen to patients symptoms in detail, such as pain alleviated with positional change/deep inspiration or pain not associated with meals and defecation. […] We suggest renaming the name of MALS as NCGAPS, nutcracker celiac ganglion abdominal pain syndrome, to better explain the mechanism of the recurrent abdominal pain and to raise awareness of the cause of the pain.
#55 A Median Arcuate Ligament Syndrome Could Be Re-termed as a Nutcracker Celiac Ganglion Abdominal Pain Syndrome
https://www.jnmjournal.org/view.html?uid=1832&vmd=Full
Median arcuate ligament syndrome (MALS) is known as chronic recurrent abdominal pain related to compression of the celiac artery by the median arcuate ligament. […] Two hypotheses of MALS etiology are well known, one due to the decrease in intravascular blood flow due to compression of the celiac artery as the pathogenesis, and the other due to overestimation by the celiac ganglion. […] Because the mechanism of MALS is unclear and it is not included in the diagnostic category for abdominal pain, some case reports of MALS have been described with rare congenital diseases or gastroparesis. […] We suggest renaming MALS as NCGAPS, nutcracker celiac ganglion abdominal pain syndrome, to better explain the mechanism of the recurrent abdominal pain. […] If the mechanism of abdominal pain in MALS is decrease in blood flow due to celiac artery compression, there should be evidence of ischemic tissue damage, but we could not find any ischemic evidence in the liver or stomach in our patients according to liver function profiles, CT, or endoscopy.
#56 Median arcuate ligament syndrome (MALS) – Symptoms and causes – Mayo Clinic
https://www.mayoclinic.org/diseases-conditions/median-arcuate-ligament-syndrome-mals/symptoms-causes/syc-20505001
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. […] The exact cause of median arcuate ligament syndrome, also called MALS, is not known. […] Because the cause of MALS is poorly understood, the risk factors are unclear. Median arcuate ligament syndrome is more common in adults than in children. It also is more common among women than among men. […] Some people have developed median arcuate ligament syndrome after pancreatic surgery or blunt injury to the upper stomach area.
#57 Mayo Clinic Health Library – Median arcuate ligament syndrome (MALS) | Swiss Medical Network
https://www.swissmedical.net/en/healtcare-library/con-20459603
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. […] The exact cause of median arcuate ligament syndrome, also called MALS, is not known. […] Because the cause of MALS is poorly understood, the risk factors are unclear. Median arcuate ligament syndrome is more common in adults than in children. It also is more common among women than among men. […] Some people have developed median arcuate ligament syndrome after pancreatic surgery or blunt injury to the upper stomach area.
#58 Median arcuate ligament syndrome (MALS) – Symptoms and causes – Mayo Clinic
https://www.mayoclinic.org/diseases-conditions/median-arcuate-ligament-syndrome-mals/symptoms-causes/syc-20505001
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. […] The exact cause of median arcuate ligament syndrome, also called MALS, is not known. […] Because the cause of MALS is poorly understood, the risk factors are unclear. Median arcuate ligament syndrome is more common in adults than in children. It also is more common among women than among men. […] Some people have developed median arcuate ligament syndrome after pancreatic surgery or blunt injury to the upper stomach area.
#59 Median arcuate ligament syndrome – Wikipedia
https://en.wikipedia.org/wiki/Median_arcuate_ligament_syndrome
The hook-shaped contour of the celiac artery is characteristic of the anatomy in MALS and helps distinguish it from other causes of celiac artery stenosis such as atherosclerosis. […] Decompression of the celiac artery is the general approach to treatment of MALS. […] The syndrome most commonly affects individuals between 20 and 40 years old, and is more common in women, particularly thin women.
#60 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. […] The primary cause of MALS is the anatomical compression of the celiac artery by the median arcuate ligament. This fibrous band usually sits above the artery but can sometimes position itself lower than usual, pressing against the artery and surrounding nerves, such as the celiac plexus and celiac ganglion. […] Several factors can increase the risk of developing MALS, including: Rapid Weight Loss: Loss of the protective fat pad surrounding the artery can increase the likelihood of compression. Anatomical Variations: Individuals with specific anatomical configurations, like the median arcuate ligament muscle and fibers, are more prone to MALS. Demographics: MALS most commonly affects women, particularly those between the ages of 20 and 40. Conditions like Dunbar Syndrome may also be associated with MALS.
#61 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). […] MALS is a rare condition, with a couple of thousand cases treated annually in the U.S. The condition most often occurs in thin, younger women. […] 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.
#62
https://journals.lww.com/ajg/fulltext/2023/10001/s4245_a_rare_cause_of_abdominal_pain__median.4243.aspx
Median arcuate ligament syndrome (MALS), also known as celiac artery compression or Dunbar syndrome, is a rare condition with an incidence of 2 per 100,000 patients involving compression of the celiac artery by the median arcuate ligament. […] MRA of the abdomen and pelvis revealed narrowing of celiac artery with a J-shaped appearance at the level of the median arcuate ligament with post stenotic dilatation consistent with MALS. […] MALS is more prevalent in women with a thin body habitus between the ages of 40 and 60. […] Diagnosis involves vascular imaging and oftentimes combined duplex ultrasound with respiratory maneuvers. […] Treatment involves a laparoscopic approach of celiac artery decompression and celiac ganglionectomy or neurolysis concurrently to address the neuropathic component. […] Clinicians should consider MALS in the evaluation of chronic abdominal pain and weight loss and recognize this rare phenomenon.
#63 Mayo Clinic Health Library – Median arcuate ligament syndrome (MALS) | Swiss Medical Network
https://www.swissmedical.net/en/healtcare-library/con-20459603
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. […] The exact cause of median arcuate ligament syndrome, also called MALS, is not known. […] Because the cause of MALS is poorly understood, the risk factors are unclear. Median arcuate ligament syndrome is more common in adults than in children. It also is more common among women than among men. […] Some people have developed median arcuate ligament syndrome after pancreatic surgery or blunt injury to the upper stomach area.
#64 Median arcuate ligament syndrome (MALS) – Hancock Health
https://www.hancockhealth.org/ja/mayo-health-library/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. […] The exact cause of median arcuate ligament syndrome, also called MALS, is not known. […] Because the cause of MALS is poorly understood, the risk factors are unclear. Median arcuate ligament syndrome is more common in adults than in children. It also is more common among women than among men. […] MALS also has been seen in identical twins, so genetics may play a role. […] Some people have developed median arcuate ligament syndrome after pancreatic surgery or blunt injury to the upper stomach area.
#65 Median Arcuate Ligament Syndrome (MALS): Laparoscopic
https://www.laparoscopicsurgeons.com/blog/median-arcuate-ligament-syndrome-mals-signs-symptoms-causes.html
Median Arcuate Ligament Syndrome (MALS) is a rare and complex condition that affects the abdominal blood vessels. […] The primary cause of MALS is the compression or entrapment of the celiac artery by the median arcuate ligament. […] Several factors can contribute to the development of this condition: Anatomical Variations: Some individuals may have a naturally lower or more prominent median arcuate ligament, which increases the likelihood of celiac artery compression. […] Body Habitus: People with a thinner body type or a low percentage of body fat may be more prone to MALS due to the decreased cushioning around the abdominal structures. […] Age and Gender: MALS is more commonly diagnosed in young to middle-aged adults, with a higher prevalence among women. […] Trauma or Injury: Abdominal trauma or injury, such as from a car accident or sports-related incident, can lead to the development of MALS by altering the normal anatomy and positioning of the median arcuate ligament. […] Underlying Medical Conditions: Certain medical conditions, such as Marfan syndrome, Ehlers-Danlos syndrome, or fibromuscular dysplasia, may increase the risk of MALS due to their effects on connective tissue and vascular structure.
#66 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. […] The primary cause of MALS is the anatomical compression of the celiac artery by the median arcuate ligament. This fibrous band usually sits above the artery but can sometimes position itself lower than usual, pressing against the artery and surrounding nerves, such as the celiac plexus and celiac ganglion. […] Several factors can increase the risk of developing MALS, including: Rapid Weight Loss: Loss of the protective fat pad surrounding the artery can increase the likelihood of compression. Anatomical Variations: Individuals with specific anatomical configurations, like the median arcuate ligament muscle and fibers, are more prone to MALS. Demographics: MALS most commonly affects women, particularly those between the ages of 20 and 40. Conditions like Dunbar Syndrome may also be associated with MALS.
#67 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. […] Severe stenosis of the celiac artery is predicted to affect 1% of patients with imaging findings of MALS. […] Recognition of MALS as a potential etiology in the diagnostic evaluation of abdominal pain is of growing clinical importance. […] Increased bariatric surgery incidence leads to a higher prevalence of patients with rapid weight loss: a major risk factor for the development of MALS. […] The celiac nerve plexus impingement in MALS can lead to a broad distribution of abdominal pain, such as further hepatic, gastric, splenic, and pancreatic plexuses. […] However, challenges in diagnosis include the nonspecific symptoms seen in the triad commonly associated with MALS: epigastric pain, weight loss, and abdominal bruit. […] Doppler vascular ultrasound to evaluate respiratory variation can help determine if compression is clinically significant and may be contributing to abdominal pain.
#68 Median Arcuate Ligament Syndrome | Society for Vascular Surgery
https://vascular.org/your-vascular-health/vascular-conditions/median-arcuate-ligament-syndrome
The median arcuate ligament is a band of hard tissue connecting the diaphragm to the spine. In median arcuate ligament syndrome (MALS), the ligament compresses the celiac artery, which supplies blood to the stomach, liver, and spleen. […] Rapid weight loss and certain anatomical factors may increase the risk for MALS.
#69 Median Arcuate Ligament Syndrome (MALS): Laparoscopic
https://www.laparoscopicsurgeons.com/blog/median-arcuate-ligament-syndrome-mals-signs-symptoms-causes.html
Median Arcuate Ligament Syndrome (MALS) is a rare and complex condition that affects the abdominal blood vessels. […] The primary cause of MALS is the compression or entrapment of the celiac artery by the median arcuate ligament. […] Several factors can contribute to the development of this condition: Anatomical Variations: Some individuals may have a naturally lower or more prominent median arcuate ligament, which increases the likelihood of celiac artery compression. […] Body Habitus: People with a thinner body type or a low percentage of body fat may be more prone to MALS due to the decreased cushioning around the abdominal structures. […] Age and Gender: MALS is more commonly diagnosed in young to middle-aged adults, with a higher prevalence among women. […] Trauma or Injury: Abdominal trauma or injury, such as from a car accident or sports-related incident, can lead to the development of MALS by altering the normal anatomy and positioning of the median arcuate ligament. […] Underlying Medical Conditions: Certain medical conditions, such as Marfan syndrome, Ehlers-Danlos syndrome, or fibromuscular dysplasia, may increase the risk of MALS due to their effects on connective tissue and vascular structure.
#70 Median Arcuate Ligament Syndrome (MALS): Laparoscopic
https://www.laparoscopicsurgeons.com/blog/median-arcuate-ligament-syndrome-mals-signs-symptoms-causes.html
Median Arcuate Ligament Syndrome (MALS) is a rare and complex condition that affects the abdominal blood vessels. […] The primary cause of MALS is the compression or entrapment of the celiac artery by the median arcuate ligament. […] Several factors can contribute to the development of this condition: Anatomical Variations: Some individuals may have a naturally lower or more prominent median arcuate ligament, which increases the likelihood of celiac artery compression. […] Body Habitus: People with a thinner body type or a low percentage of body fat may be more prone to MALS due to the decreased cushioning around the abdominal structures. […] Age and Gender: MALS is more commonly diagnosed in young to middle-aged adults, with a higher prevalence among women. […] Trauma or Injury: Abdominal trauma or injury, such as from a car accident or sports-related incident, can lead to the development of MALS by altering the normal anatomy and positioning of the median arcuate ligament. […] Underlying Medical Conditions: Certain medical conditions, such as Marfan syndrome, Ehlers-Danlos syndrome, or fibromuscular dysplasia, may increase the risk of MALS due to their effects on connective tissue and vascular structure.
#71 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. […] The exact cause of MALS is not always clear. However, several factors may contribute to its development. The lower abdominal aorta occasionally becomes compressed when the median arcuate ligament crosses it. The celiac axis and other vasculature frequently shift upward during expiration, increasing compression. […] In addition, anatomical changes might worsen the narrowing of the celiac artery, resulting in MALS, such as a low-lying or more fibrous median arcuate ligament, fibromuscular dysplasia, or atherosclerosis. […] Causes of this disease may involve anatomical changes or vascular shifts during expiration that compress the celiac artery, impairing blood flow and causing various symptoms.
#72 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. MALS is caused when the ligament descends lower or the celiac artery is anatomically positioned higher on the Aorta causing the ligament to cross over and compress the celiac artery and surrounding tissue which can include the celiac plexus nerves. As of right now there are multiple theories of why MALS occurs within the body. Some of those theories are that this structural anomaly could be congenital, meaning from birth or develop after spinal surgery, abdominal surgery or due to abdominal trauma. […] Compromised blood flow and inflammation results in changes in oxygen levels (hypoxia/HIF factor and oxidative stress) and nutrients to the abdominal organs and nerves which can result in consequential damage.
#73 MALS (Median Arcuate Ligament Syndrome): Symptoms & Diagnosis
https://my.clevelandclinic.org/health/diseases/16635-median-arcuate-ligament-syndrome-mals
Median arcuate ligament syndrome (MALS) refers to a condition that happens when the median arcuate ligament in your chest presses against your celiac artery and nearby nerves (celiac plexus). […] Experts dont know the exact reason why it happens. Some researchers suggest people are born with a median arcuate ligament thats not in the right place. Another theory is MALS is a complication of abdominal or spinal surgery or abdominal trauma.
#74 Median arcuate ligament syndrome (MALS) – Symptoms and causes – Mayo Clinic
https://www.mayoclinic.org/diseases-conditions/median-arcuate-ligament-syndrome-mals/symptoms-causes/syc-20505001
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. […] The exact cause of median arcuate ligament syndrome, also called MALS, is not known. […] Because the cause of MALS is poorly understood, the risk factors are unclear. Median arcuate ligament syndrome is more common in adults than in children. It also is more common among women than among men. […] Some people have developed median arcuate ligament syndrome after pancreatic surgery or blunt injury to the upper stomach area.
#75 Mayo Clinic Health Library – Median arcuate ligament syndrome (MALS) | Swiss Medical Network
https://www.swissmedical.net/en/healtcare-library/con-20459603
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. […] The exact cause of median arcuate ligament syndrome, also called MALS, is not known. […] Because the cause of MALS is poorly understood, the risk factors are unclear. Median arcuate ligament syndrome is more common in adults than in children. It also is more common among women than among men. […] Some people have developed median arcuate ligament syndrome after pancreatic surgery or blunt injury to the upper stomach area.
#76 Median Arcuate Ligament Syndrome: From Diagnosis to Multidisciplinary ManagementâA Narrative Review
https://www.mdpi.com/2813-2475/4/1/11
Median Arcuate Ligament Syndrome (MALS) also known as Dunbarâs syndrome is one of the main factors leading to Celiac Artery Stenosis (CAS). […] Causes of CAS can be internal such as atherosclerosis, or external such as pancreatitis, malignant tumors, or MALS. […] MALS is defined as external compression of the celiac trunk and celiac plexus by the fibrous arch connecting the diaphragmatic crura, or MAL. […] Individuals with a higher position of celiac artery or a lower position of median arcuate ligament are predisposed to this condition. […] This very rare syndrome affecting 0.002% of the population, and its diagnostic and surgical management are not well defined. […] The characteristic presentation of a patient with MALS is that of a young female, without comorbidities of atherosclerotic phenotype.
#77 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. […] Severe stenosis of the celiac artery is predicted to affect 1% of patients with imaging findings of MALS. […] Recognition of MALS as a potential etiology in the diagnostic evaluation of abdominal pain is of growing clinical importance. […] Increased bariatric surgery incidence leads to a higher prevalence of patients with rapid weight loss: a major risk factor for the development of MALS. […] The celiac nerve plexus impingement in MALS can lead to a broad distribution of abdominal pain, such as further hepatic, gastric, splenic, and pancreatic plexuses. […] However, challenges in diagnosis include the nonspecific symptoms seen in the triad commonly associated with MALS: epigastric pain, weight loss, and abdominal bruit. […] Doppler vascular ultrasound to evaluate respiratory variation can help determine if compression is clinically significant and may be contributing to abdominal pain.
#78 Median Arcuate Ligament Syndrome: From Diagnosis to Multidisciplinary ManagementâA Narrative Review
https://www.mdpi.com/2813-2475/4/1/11
Median Arcuate Ligament Syndrome (MALS) also known as Dunbarâs syndrome is one of the main factors leading to Celiac Artery Stenosis (CAS). […] Causes of CAS can be internal such as atherosclerosis, or external such as pancreatitis, malignant tumors, or MALS. […] MALS is defined as external compression of the celiac trunk and celiac plexus by the fibrous arch connecting the diaphragmatic crura, or MAL. […] Individuals with a higher position of celiac artery or a lower position of median arcuate ligament are predisposed to this condition. […] This very rare syndrome affecting 0.002% of the population, and its diagnostic and surgical management are not well defined. […] The characteristic presentation of a patient with MALS is that of a young female, without comorbidities of atherosclerotic phenotype.
#79 Median arcuate ligament syndrome: Incidental finding or real problem? | Cleveland Clinic Journal of Medicine
https://www.ccjm.org/content/88/3/140
Median arcuate ligament syndrome, 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. […] Theories regarding the pathophysiology of epigastric pain associated with MALS include foregut ischemia due to compressed celiac artery, midgut ischemia due to vascular steal syndrome, and overstimulation of the celiac plexus with subsequent splanchnic vasoconstriction and ischemia. Recently, ideas about the etiology of MALS have shifted from its being a vascular disease to a neurogenic disorder with compression of the surrounding celiac plexus and ganglion. […] Anatomically, up to 24% of the population may have compression of the celiac artery; however, fewer than 1% of them have symptoms.
#80 Median Arcuate Ligament Syndrome: From Diagnosis to Multidisciplinary ManagementâA Narrative Review
https://www.mdpi.com/2813-2475/4/1/11
MALS may remain asymptomatic in up to 25% of affected patients, while, according to different article, between 15% and 50% of asymptomatic cases can still be identified. […] The most common associated symptoms include postprandial abdominal pain, nausea and vomiting, weight loss, bloating, abdominal bruit and increased epigastric tenderness. […] The presentation of clinical symptoms is due to hemodynamic disturbances in the CA, leading to malperfusion of visceral organs supplied by this vessel such as the spleen, pancreas, liver, stomach and proximal part of the duodenum. […] Symptoms are caused by vascular and neuropathic components. […] The vascular component is responsible for a decrease in blood flow due to compression of the CT. […] The neuropathic component, on the contrary, results in irritation of the celiac plexus and visceral pain.
#81 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. […] Median arcuate ligament syndrome (MALS) refers to the external compression of the coeliac plexus by the median arcuate ligament (MAL) with resulting symptoms. […] Compression alone is a common radiological finding in approximately 25% of the population; however, only 1% of the population have corresponding symptoms. […] Chronic compression by this ligament can lead to hyperplastic intimal changes of the coeliac artery. […] This might progress to cause stenosis or complete arterial occlusion, along with post-stenotic dilation and coeliac artery aneurysms. […] The pathophysiology of MALS is unclear, and multiple theories have been discussed in the literature.
#82 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. […] Severe stenosis of the celiac artery is predicted to affect 1% of patients with imaging findings of MALS. […] Recognition of MALS as a potential etiology in the diagnostic evaluation of abdominal pain is of growing clinical importance. […] Increased bariatric surgery incidence leads to a higher prevalence of patients with rapid weight loss: a major risk factor for the development of MALS. […] The celiac nerve plexus impingement in MALS can lead to a broad distribution of abdominal pain, such as further hepatic, gastric, splenic, and pancreatic plexuses. […] However, challenges in diagnosis include the nonspecific symptoms seen in the triad commonly associated with MALS: epigastric pain, weight loss, and abdominal bruit. […] Doppler vascular ultrasound to evaluate respiratory variation can help determine if compression is clinically significant and may be contributing to abdominal pain.
#83 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). […] MALS is a rare condition, with a couple of thousand cases treated annually in the U.S. The condition most often occurs in thin, younger women. […] 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.
#84 Overview of Median Arcuate Ligament Syndrome: A Narrative Review
https://pmc.ncbi.nlm.nih.gov/articles/PMC10629207/
Median arcuate ligament syndrome (MALS) is a rare disorder caused primarily by compression of the celiac trunk by the median arcuate ligament (MAL). […] It is believed to be caused by the constriction of the celiac artery and the celiac plexus by the median arcuate ligament (MAL). […] While the reason for this anatomical malformation is unknown, it is believed that both hereditary and environmental factors likely play a role in the development of MALS. […] Due to this abnormal anatomical structure, the celiac artery and the celiac plexus are compressed by the MAL. […] This compression may result in hyperplasia of the intimal wall of the celiac artery, thus causing stenosis of its lumen and ultimately resulting in ischemia of the abdominal organs. […] The symptoms of MALS are believed to be due to the abnormally low insertion of the MAL, which occurs because of errors in embryological development.
#85 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
It is thought that the compression of the coeliac artery can cause foregut pain and ischaemia during increased demand when patients eat. […] Some postulate that a steal phenomenon occurs due to significant collateral circulation causing blood to be diverted away from the midgut to the foregut following meals, resulting in midgut ischaemia and pain. […] Further theories include that overstimulation of the coeliac plexus causes significant vasoconstriction, which results in ischaemic abdominal pain and the entrapment of the coeliac ganglion, altering gastric myoelectrical activity, impairing antral motility and causing neurogenic pain. […] The prevalence of MALS remains unclear, which is partly due to its variable clinical presentation. […] MALS occurs most commonly in young women. […] MALS does not have universally accepted diagnostic criteria.
#86 Median arcuate ligament syndrome (Dunbar syndrome) – Iqbal – Cardiovascular Diagnosis and Therapy
https://cdt.amegroups.org/article/view/67298/html
Median arcuate ligament syndrome (MALS) is a rare condition which is due to the compression of celiac trunk by low riding of fibrous attachments of median arcuate ligament and diaphragmatic crura. […] The higher origin of celiac artery or lower insertion of diaphragmatic crura are likely to lead to MALS. […] Sometimes median arcuate ligament crosses the lower abdominal aorta causing compression. […] Compression can be due to thick, fibrous tissue or thin bands at or near the origin of celiac artery. […] The treatment of MALS aims at decompression of celiac artery to establish adequate blood flow and pain management by neurolysis. […] The neuropathic pain of MALS can be addressed with removal or ablation of ganglion and celiac artery revascularization. […] The role of intervention radiology is emerging in the treatment of MALS, though its outcomes are not promising. […] This may be due to the extrinsic compression of celiac artery causing intimal hyperplasia resulting luminal narrowing of artery. […] However, further definitive studies are needed to address the pathophysiology, better diagnose and devise minimally invasive treatment for this entity.
#87 Median Arcuate Ligament Syndrome: From Diagnosis to Multidisciplinary ManagementâA Narrative Review
https://www.mdpi.com/2813-2475/4/1/11
MALS may remain asymptomatic in up to 25% of affected patients, while, according to different article, between 15% and 50% of asymptomatic cases can still be identified. […] The most common associated symptoms include postprandial abdominal pain, nausea and vomiting, weight loss, bloating, abdominal bruit and increased epigastric tenderness. […] The presentation of clinical symptoms is due to hemodynamic disturbances in the CA, leading to malperfusion of visceral organs supplied by this vessel such as the spleen, pancreas, liver, stomach and proximal part of the duodenum. […] Symptoms are caused by vascular and neuropathic components. […] The vascular component is responsible for a decrease in blood flow due to compression of the CT. […] The neuropathic component, on the contrary, results in irritation of the celiac plexus and visceral pain.
#88 Median arcuate ligament syndrome – UpToDate
https://www.uptodate.com/contents/median-arcuate-ligament-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. […] The etiology and pathophysiology of MALS are incompletely understood but may be related to both ischemic and neuropathic mechanisms. […] A subset of patients (approximately 10 percent) has an abnormally positioned median arcuate ligament that appears to compress an otherwise normally positioned celiac artery. […] 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.
#89 Median arcuate ligament syndrome: A clinical dilemma | Cleveland Clinic Journal of Medicine
https://www.ccjm.org/content/88/3/143
Compression of the celiac artery was first described in 1917 by Lipshutz, but it took almost 50 years to understand any clinical implication. […] The triad of epigastric abdominal pain exacerbated by eating, weight loss, and celiac artery compression was initially described in 1963 by Harjola, leading to the first description of median arcuate ligament syndrome (MALS). […] To this day, controversy persists around the pathology of this syndrome, with some groups labeling it a vascular disease, while others consider it a neurogenic disease. […] Variation of flow during inspiration and expiration has proven to be one of the most reliable modalities to document true compression with hemodynamic consequences. […] MALS is considered a diagnosis of exclusion, and therefore, testing to exclude other foregut pathology should be considered.
#90 Overview of Median Arcuate Ligament Syndrome: A Narrative Review
https://pmc.ncbi.nlm.nih.gov/articles/PMC10629207/
Median arcuate ligament syndrome (MALS) is a rare disorder caused primarily by compression of the celiac trunk by the median arcuate ligament (MAL). […] It is believed to be caused by the constriction of the celiac artery and the celiac plexus by the median arcuate ligament (MAL). […] While the reason for this anatomical malformation is unknown, it is believed that both hereditary and environmental factors likely play a role in the development of MALS. […] Due to this abnormal anatomical structure, the celiac artery and the celiac plexus are compressed by the MAL. […] This compression may result in hyperplasia of the intimal wall of the celiac artery, thus causing stenosis of its lumen and ultimately resulting in ischemia of the abdominal organs. […] The symptoms of MALS are believed to be due to the abnormally low insertion of the MAL, which occurs because of errors in embryological development.
#91 Median arcuate ligament syndrome – Wikipedia
https://en.wikipedia.org/wiki/Median_arcuate_ligament_syndrome
The hook-shaped contour of the celiac artery is characteristic of the anatomy in MALS and helps distinguish it from other causes of celiac artery stenosis such as atherosclerosis. […] Decompression of the celiac artery is the general approach to treatment of MALS. […] The syndrome most commonly affects individuals between 20 and 40 years old, and is more common in women, particularly thin women.
#92 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. […] This is known as median arcuate ligament syndrome (MALS). This condition is also known as celiac artery compression syndrome, Dunbar syndrome, or Harjola-Marable syndrome. […] Abnormally low insertion of this ligament can lead to MALS. […] The suffered group is usually young lean females between the age of 30 and 50 years and present with abdominal pain. […] 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. […] Conventional catheter angiography was the imaging modality of the choice for MALS in the past. […] Surgical median arcuate ligament release has been the mainstay of treatment.
#93 Median arcuate ligament syndrome – Wikipedia
https://en.wikipedia.org/wiki/Median_arcuate_ligament_syndrome
The hook-shaped contour of the celiac artery is characteristic of the anatomy in MALS and helps distinguish it from other causes of celiac artery stenosis such as atherosclerosis. […] Decompression of the celiac artery is the general approach to treatment of MALS. […] The syndrome most commonly affects individuals between 20 and 40 years old, and is more common in women, particularly thin women.
#94
https://journals.lww.com/ajg/fulltext/2023/10001/s4245_a_rare_cause_of_abdominal_pain__median.4243.aspx
Median arcuate ligament syndrome (MALS), also known as celiac artery compression or Dunbar syndrome, is a rare condition with an incidence of 2 per 100,000 patients involving compression of the celiac artery by the median arcuate ligament. […] MRA of the abdomen and pelvis revealed narrowing of celiac artery with a J-shaped appearance at the level of the median arcuate ligament with post stenotic dilatation consistent with MALS. […] MALS is more prevalent in women with a thin body habitus between the ages of 40 and 60. […] Diagnosis involves vascular imaging and oftentimes combined duplex ultrasound with respiratory maneuvers. […] Treatment involves a laparoscopic approach of celiac artery decompression and celiac ganglionectomy or neurolysis concurrently to address the neuropathic component. […] Clinicians should consider MALS in the evaluation of chronic abdominal pain and weight loss and recognize this rare phenomenon.
#95 Median Arcuate Ligament Syndrome: From Diagnosis to Multidisciplinary ManagementâA Narrative Review
https://www.mdpi.com/2813-2475/4/1/11
In addition, chronic compression of the CA by the MAL may promote the formation of aneurysms within the visceral arteries branching from the CA, such as aneurysms in the pancreatoduodenal artery arch. […] It is important to point out that in both paediatric and adult patients affected by MALS, psychiatric symptoms such as anxiety and depression are common. […] However, depression or anxiety may not disappear despite the resolution of symptoms in the post-operative period, so psychological care and the use of behavioral-cognitive therapy in such patients is extremely important.
#96 Laparoscopic median arcuate ligament section for median arcuate ligament compression syndrome initially detected as splenic infarction: a case report | Surgical Case Reports | Full Text
https://surgicalcasereports.springeropen.com/articles/10.1186/s40792-024-01817-w
Median arcuate ligament compression syndrome (MALS) causes upper abdominal pain and at times hemodynamic abnormalities in the pancreaticoduodenal region. […] MALS may causes hemodynamic abnormalities including aneurysm rupture around the pancreaticoduodenal region. […] MALS is rarely detected in splenic infarction. […] In this case, median arcuate ligament compression syndrome caused splenic infarction by reducing blood flow to the splenic artery. […] MALS can cause hemodynamic abnormalities in the pancreaticoduodenal region. […] It has been reported that 6874% of patients with pancreaticoduodenal aneurysms have stenosis of the origin of the CA, and 80% of patients with stenosis of the origin of the CA have arterial dilatation of the pancreatic head arcade. […] Although splenic infarction due to decreased blood flow in the splenic artery is a rare complication in MALS, it should be kept in mind.
#97 Median Arcuate Ligament Syndrome – Practical Gastro
https://practicalgastro.com/2015/02/05/median-arcuate-ligament-syndrome/
Median arcuate ligament syndrome (MALS), also known as celiac artery compression syndrome (CACS), Dunbar syndrome and celiac axis syndrome is a cause of chronic epigastric and right upper quadrant abdominal pain that is explained by the median arcuate ligament, a fibrous tissue connecting the two crura of the diaphragm, compressing the celiac artery and its companion structure, the celiac ganglion. Theories explaining the pathophysiology of the disease suggest either neurogenic or vascular origin. […] It was first suggested that the compromise of blood supply by compression of the celiac artery would lead to post prandial ischemia and hence worse abdominal pain. However the SMA and IMA are widely patent in this entity and the stomach has extensive collateral blood flow from the gastric and epiploic arcades leading to the conclusion that ischemia is not the explanation for the abdominal pain and other associated symptoms. It was suggested later that pressure on the celiac plexus might be the main etiological factor in MALS and thus it could also explain the accompanying findings often present in addition to the abdominal pain, namely nausea, vomiting, gastroparesis, and gastric electrical dysrhythmias.
#98 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. […] Because the median arcuate ligament is compressing both the celiac artery and the celiac ganglion nerves, there is debate as to whether the cause of pain is ischemic (caused by blood flow) or neurogenic (caused by the nerves). […] Many doctors believe MALS is a vascular issue however, this does not explain the pain patients feel, nor does it address those patients who continue to suffer despite having adequate blood flow through the celiac artery. […] Those who believe MALS is a neurologic issue focus on the celiac ganglion as the main cause of a patients symptoms. Because of the pressure on the nerves, they have become inflamed beyond the point of repair. These inflamed nerves must be addressed to resolve the patients disabling pain.
#99 Median Arcuate Ligament Syndrome (MALS) Los Angeles
https://www.drdannyshouhed.com/median-arcuate-ligament-syndrome
Median arcuate ligament syndrome, or (MALS), is a rare, complex, under-diagnosed disease that often causes chronic, debilitating pain in the upper part of the abdomen. […] People with MALS are born with an anatomic abnormality of the their diaphragm and median arcuate ligament, causing the median arcuate ligament to compress the celiac artery, a major branch of the abdominal aorta, and the celiac nerve ganglion and plexus of nerves. […] This pressure can lead to blood flow changes, as well as nerve entrapment and inflammation, resulting in extreme pain, sitophobia (fear of eating), significant weight loss, constipation and diarrhea.
#100 Median arcuate ligament syndrome: Incidental finding or real problem? | Cleveland Clinic Journal of Medicine
https://www.ccjm.org/content/88/3/140
Median arcuate ligament syndrome, 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. […] Theories regarding the pathophysiology of epigastric pain associated with MALS include foregut ischemia due to compressed celiac artery, midgut ischemia due to vascular steal syndrome, and overstimulation of the celiac plexus with subsequent splanchnic vasoconstriction and ischemia. Recently, ideas about the etiology of MALS have shifted from its being a vascular disease to a neurogenic disorder with compression of the surrounding celiac plexus and ganglion. […] Anatomically, up to 24% of the population may have compression of the celiac artery; however, fewer than 1% of them have symptoms.
#101 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
It is thought that the compression of the coeliac artery can cause foregut pain and ischaemia during increased demand when patients eat. […] Some postulate that a steal phenomenon occurs due to significant collateral circulation causing blood to be diverted away from the midgut to the foregut following meals, resulting in midgut ischaemia and pain. […] Further theories include that overstimulation of the coeliac plexus causes significant vasoconstriction, which results in ischaemic abdominal pain and the entrapment of the coeliac ganglion, altering gastric myoelectrical activity, impairing antral motility and causing neurogenic pain. […] The prevalence of MALS remains unclear, which is partly due to its variable clinical presentation. […] MALS occurs most commonly in young women. […] MALS does not have universally accepted diagnostic criteria.
#102 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
It is thought that the compression of the coeliac artery can cause foregut pain and ischaemia during increased demand when patients eat. […] Some postulate that a steal phenomenon occurs due to significant collateral circulation causing blood to be diverted away from the midgut to the foregut following meals, resulting in midgut ischaemia and pain. […] Further theories include that overstimulation of the coeliac plexus causes significant vasoconstriction, which results in ischaemic abdominal pain and the entrapment of the coeliac ganglion, altering gastric myoelectrical activity, impairing antral motility and causing neurogenic pain. […] The prevalence of MALS remains unclear, which is partly due to its variable clinical presentation. […] MALS occurs most commonly in young women. […] MALS does not have universally accepted diagnostic criteria.
#103 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
It is thought that the compression of the coeliac artery can cause foregut pain and ischaemia during increased demand when patients eat. […] Some postulate that a steal phenomenon occurs due to significant collateral circulation causing blood to be diverted away from the midgut to the foregut following meals, resulting in midgut ischaemia and pain. […] Further theories include that overstimulation of the coeliac plexus causes significant vasoconstriction, which results in ischaemic abdominal pain and the entrapment of the coeliac ganglion, altering gastric myoelectrical activity, impairing antral motility and causing neurogenic pain. […] The prevalence of MALS remains unclear, which is partly due to its variable clinical presentation. […] MALS occurs most commonly in young women. […] MALS does not have universally accepted diagnostic criteria.
#104 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. […] Severe stenosis of the celiac artery is predicted to affect 1% of patients with imaging findings of MALS. […] Recognition of MALS as a potential etiology in the diagnostic evaluation of abdominal pain is of growing clinical importance. […] Increased bariatric surgery incidence leads to a higher prevalence of patients with rapid weight loss: a major risk factor for the development of MALS. […] The celiac nerve plexus impingement in MALS can lead to a broad distribution of abdominal pain, such as further hepatic, gastric, splenic, and pancreatic plexuses. […] However, challenges in diagnosis include the nonspecific symptoms seen in the triad commonly associated with MALS: epigastric pain, weight loss, and abdominal bruit. […] Doppler vascular ultrasound to evaluate respiratory variation can help determine if compression is clinically significant and may be contributing to abdominal pain.
#105 Median Arcuate Ligament Syndrome: A Cause of Postprandial Abdominal Pain in a Patient With Ulcerative Colitis | Hill | Journal of Medical Cases
https://www.journalmc.org/index.php/JMC/article/view/1773/1147
Median arcuate ligament syndrome (MALS) is a condition caused by the external compression of the celiac artery by the median arcuate ligament. […] The pathophysiology of the pain is debated between ischemia due to celiac artery compression and neurogenic disturbance from celiac plexus compression. […] MALS has been linked to the development of other gastrointestinal disorders such as gastroparesis. […] The goal of treatment of MALS is restoring normal blood flow in the celiac axis. […] The consequence of chronic celiac trunk compression is unknown. […] Additionally, it provokes the question of whether MALS can lead to other abdominal pathologies.
#106 What is Median Arcuate Ligament Syndrome (MALS)? — Accountability Muse
https://www.accountabilitymuse.com/blog/what-is-median-arcuate-ligament-syndrome-mals
„It can also be developmental. So for example, with growth spurts, connective tissue disorders and lordosis.” […] „The other thing that can happen is just an alteration of anatomy, either from abdominal or spinal surgery or abdominal trauma.” […] „Median Arcuate Ligament Syndrome (MALS) is a rare entity characterized by severe post-prandial epigastric pain, nausea, vomiting, and/or weight loss.” […] „Symptoms have been attributed to vascular compression (celiac artery compression syndrome, CACS), but it remains controversial whether they could be secondary to neural compression.” […] „Our findings support neurogenic compression as a contributing factor in the development of pain and other MALS symptoms, and favor the use of MALS rather than CACS as diagnostic terminology.” […] „It is notable that these conditions are more prevalent in the MALS population than in the general population, suggesting a possible pathophysiologic relationship.”
#107 Median Arcuate Ligament Syndrome: A Cause of Postprandial Abdominal Pain in a Patient With Ulcerative Colitis | Hill | Journal of Medical Cases
https://www.journalmc.org/index.php/JMC/article/view/1773/1147
Median arcuate ligament syndrome (MALS) is a condition caused by the external compression of the celiac artery by the median arcuate ligament. […] The pathophysiology of the pain is debated between ischemia due to celiac artery compression and neurogenic disturbance from celiac plexus compression. […] MALS has been linked to the development of other gastrointestinal disorders such as gastroparesis. […] The goal of treatment of MALS is restoring normal blood flow in the celiac axis. […] The consequence of chronic celiac trunk compression is unknown. […] Additionally, it provokes the question of whether MALS can lead to other abdominal pathologies.
#108 A Median Arcuate Ligament Syndrome Could Be Re-termed as a Nutcracker Celiac Ganglion Abdominal Pain Syndrome
https://www.jnmjournal.org/journal/view.html?volume=29&number=2&spage=200
Median arcuate ligament syndrome (MALS) is known as chronic recurrent abdominal pain related to compression of the celiac artery by the median arcuate ligament. […] Two hypotheses of MALS etiology are well known, one due to the decrease in intravascular blood flow due to compression of the celiac artery as the pathogenesis, and the other due to overestimation by the celiac ganglion. […] The mechanism of MALS is unclear and it is not included in the diagnostic category for abdominal pain, some case reports of MALS have been described with rare congenital diseases or gastroparesis. […] We suggest renaming MALS as NCGAPS, nutcracker celiac ganglion abdominal pain syndrome, to better explain the mechanism of the recurrent abdominal pain. […] If the mechanism of abdominal pain in MALS is decrease in blood flow due to celiac artery compression, there should be evidence of ischemic tissue damage, but we could not find any ischemic evidence in the liver or stomach in our patients according to liver function profiles, CT, or endoscopy.
#109 Median Arcuate Ligament Syndrome: From Diagnosis to Multidisciplinary ManagementâA Narrative Review
https://www.mdpi.com/2813-2475/4/1/11
In addition, chronic compression of the CA by the MAL may promote the formation of aneurysms within the visceral arteries branching from the CA, such as aneurysms in the pancreatoduodenal artery arch. […] It is important to point out that in both paediatric and adult patients affected by MALS, psychiatric symptoms such as anxiety and depression are common. […] However, depression or anxiety may not disappear despite the resolution of symptoms in the post-operative period, so psychological care and the use of behavioral-cognitive therapy in such patients is extremely important.
#110 Median Arcuate Ligament Syndrome (MALS) Los Angeles
https://www.drdannyshouhed.com/median-arcuate-ligament-syndrome
Median arcuate ligament syndrome, or (MALS), is a rare, complex, under-diagnosed disease that often causes chronic, debilitating pain in the upper part of the abdomen. […] People with MALS are born with an anatomic abnormality of the their diaphragm and median arcuate ligament, causing the median arcuate ligament to compress the celiac artery, a major branch of the abdominal aorta, and the celiac nerve ganglion and plexus of nerves. […] This pressure can lead to blood flow changes, as well as nerve entrapment and inflammation, resulting in extreme pain, sitophobia (fear of eating), significant weight loss, constipation and diarrhea.
#111 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. […] The etiology and pathophysiology of MALS remain poorly understood but are believed to involve both ischemic and neuropathic components. […] Median arcuate ligament syndrome is a rare cause of chronic abdominal pain that poses a diagnostic challenge, particularly in pediatric patients. […] Vascular etiologies such as MALS should be considered when previous workup and management have failed to provide a definitive diagnosis.
#112 Triad of MALS, Celiac Artery Dissection, and Fibrillin-1 Gene Variance of Unknown Significance | ACS
https://www.facs.org/for-medical-professionals/news-publications/journals/case-reviews/issues/v4n3/09-kirskey-triad-of-unknown-significance/
Spontaneous celiac artery dissection is a rare vascular event with an unclear incidence. […] Two similarly rare conditions suggested to predispose individuals to celiac artery dissection are median arcuate ligament syndrome (MALS) and connective tissue disorders. […] We present a unique patient who had radiographic evidence of celiac artery dissection, sonographic evidence of increased arterial flow velocities in the setting of MALS, and an uncommon fibrillin gene variance likely manifesting as a predisposing collagen vascular disorder. […] Median arcuate ligament compression is present as a normal anatomic variation in a significant proportion of the population; therefore, a celiac plexus block can assist in confirming the diagnosis of MALS. […] Our patient’s symptoms were consistent with MALS.
#113 Triad of MALS, Celiac Artery Dissection, and Fibrillin-1 Gene Variance of Unknown Significance | ACS
https://www.facs.org/for-medical-professionals/news-publications/journals/case-reviews/issues/v4n3/09-kirskey-triad-of-unknown-significance/
The diagnosis of MALS is ultimately achieved by a combination of duplex ultrasound, CTA, or MRA and correlating patient symptoms. […] Given her presentation and familial history, this patient underwent prior genetic workup due to high suspicion for a connective tissue disorder. […] We believe the widespread nature of spontaneous visceral arterial dissection in this patient, which included not only the celiac artery and its immediate branches but also spontaneous dissection of the right renal artery, could be reflective of genetic predisposition to arteriopathy secondary to fibrillin-1 gene variance. […] Our patient underwent median arcuate ligament release due to the presumptive diagnosis of MALS. […] In appropriate cases of MALS, minimally invasive median arcuate ligament release should be offered as it may improve vascular complications and patient symptoms.
#114 Laparoscopic median arcuate ligament section for median arcuate ligament compression syndrome initially detected as splenic infarction: a case report | Surgical Case Reports | Full Text
https://surgicalcasereports.springeropen.com/articles/10.1186/s40792-024-01817-w
Median arcuate ligament compression syndrome (MALS) causes upper abdominal pain and at times hemodynamic abnormalities in the pancreaticoduodenal region. […] MALS may causes hemodynamic abnormalities including aneurysm rupture around the pancreaticoduodenal region. […] MALS is rarely detected in splenic infarction. […] In this case, median arcuate ligament compression syndrome caused splenic infarction by reducing blood flow to the splenic artery. […] MALS can cause hemodynamic abnormalities in the pancreaticoduodenal region. […] It has been reported that 6874% of patients with pancreaticoduodenal aneurysms have stenosis of the origin of the CA, and 80% of patients with stenosis of the origin of the CA have arterial dilatation of the pancreatic head arcade. […] Although splenic infarction due to decreased blood flow in the splenic artery is a rare complication in MALS, it should be kept in mind.
#115 Triad of MALS, Celiac Artery Dissection, and Fibrillin-1 Gene Variance of Unknown Significance | ACS
https://www.facs.org/for-medical-professionals/news-publications/journals/case-reviews/issues/v4n3/09-kirskey-triad-of-unknown-significance/
Spontaneous celiac artery dissection is a rare vascular event with an unclear incidence. […] Two similarly rare conditions suggested to predispose individuals to celiac artery dissection are median arcuate ligament syndrome (MALS) and connective tissue disorders. […] We present a unique patient who had radiographic evidence of celiac artery dissection, sonographic evidence of increased arterial flow velocities in the setting of MALS, and an uncommon fibrillin gene variance likely manifesting as a predisposing collagen vascular disorder. […] Median arcuate ligament compression is present as a normal anatomic variation in a significant proportion of the population; therefore, a celiac plexus block can assist in confirming the diagnosis of MALS. […] Our patient’s symptoms were consistent with MALS.
#116
https://www.tropicalgastro.com/articles/41/1/Median-Arcuate-Ligament-Syndrome-Rare-Cause-of-Post-Prandial-Abdominal-Pain.html
Median arcuate ligament syndrome (MALS) is a condition characterized by chronic, recurrent abdominal pain due to compression of the celiac artery by the median arcuate ligament of the diaphragm. […] The postulated mechanisms of MALS are both ischemic and neuropathic. Compression of the celiac artery occurs due to the abnormally low-lying ligament. […] An acquired transient form of the syndrome has also been reported following blunt abdominal trauma and pancreatic surgical procedures, such as pancreaticoduodenectomy; likely related to the local trauma and resultant edema. […] A definitive diagnosis of MALS requires vascular imaging to confirm compression of the celiac artery by the median arcuate ligament (duplex ultrasound combined with advanced vascular imaging), preferably with respiratory maneuvers.
#117 Median Arcuate Ligament Syndrome Following Trauma | CTSNet
https://www.ctsnet.org/article/median-arcuate-ligament-syndrome-following-trauma
The MAL syndrome is a fairly rare condition with a tedious diagnostic workup. […] The study by Kruchareon et al. showed no statistical difference in postoperative pain between open, laparoscopic, and robotic approaches for MAL release. […] Another observed improvement is the achievement of successful results with only a MAL release, without any dissection of the crura.
#118
https://www.tropicalgastro.com/articles/41/1/Median-Arcuate-Ligament-Syndrome-Rare-Cause-of-Post-Prandial-Abdominal-Pain.html
Median arcuate ligament syndrome (MALS) is a condition characterized by chronic, recurrent abdominal pain due to compression of the celiac artery by the median arcuate ligament of the diaphragm. […] The postulated mechanisms of MALS are both ischemic and neuropathic. Compression of the celiac artery occurs due to the abnormally low-lying ligament. […] An acquired transient form of the syndrome has also been reported following blunt abdominal trauma and pancreatic surgical procedures, such as pancreaticoduodenectomy; likely related to the local trauma and resultant edema. […] A definitive diagnosis of MALS requires vascular imaging to confirm compression of the celiac artery by the median arcuate ligament (duplex ultrasound combined with advanced vascular imaging), preferably with respiratory maneuvers.
#119
https://www.tropicalgastro.com/articles/41/1/Median-Arcuate-Ligament-Syndrome-Rare-Cause-of-Post-Prandial-Abdominal-Pain.html
Median arcuate ligament syndrome (MALS) is a condition characterized by chronic, recurrent abdominal pain due to compression of the celiac artery by the median arcuate ligament of the diaphragm. […] The postulated mechanisms of MALS are both ischemic and neuropathic. Compression of the celiac artery occurs due to the abnormally low-lying ligament. […] An acquired transient form of the syndrome has also been reported following blunt abdominal trauma and pancreatic surgical procedures, such as pancreaticoduodenectomy; likely related to the local trauma and resultant edema. […] A definitive diagnosis of MALS requires vascular imaging to confirm compression of the celiac artery by the median arcuate ligament (duplex ultrasound combined with advanced vascular imaging), preferably with respiratory maneuvers.
#120 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. MALS is caused when the ligament descends lower or the celiac artery is anatomically positioned higher on the Aorta causing the ligament to cross over and compress the celiac artery and surrounding tissue which can include the celiac plexus nerves. As of right now there are multiple theories of why MALS occurs within the body. Some of those theories are that this structural anomaly could be congenital, meaning from birth or develop after spinal surgery, abdominal surgery or due to abdominal trauma. […] Compromised blood flow and inflammation results in changes in oxygen levels (hypoxia/HIF factor and oxidative stress) and nutrients to the abdominal organs and nerves which can result in consequential damage.
#121 Median Arcuate Ligament Syndrome (MALS): Laparoscopic
https://www.laparoscopicsurgeons.com/blog/median-arcuate-ligament-syndrome-mals-signs-symptoms-causes.html
Median Arcuate Ligament Syndrome (MALS) is a rare and complex condition that affects the abdominal blood vessels. […] The primary cause of MALS is the compression or entrapment of the celiac artery by the median arcuate ligament. […] Several factors can contribute to the development of this condition: Anatomical Variations: Some individuals may have a naturally lower or more prominent median arcuate ligament, which increases the likelihood of celiac artery compression. […] Body Habitus: People with a thinner body type or a low percentage of body fat may be more prone to MALS due to the decreased cushioning around the abdominal structures. […] Age and Gender: MALS is more commonly diagnosed in young to middle-aged adults, with a higher prevalence among women. […] Trauma or Injury: Abdominal trauma or injury, such as from a car accident or sports-related incident, can lead to the development of MALS by altering the normal anatomy and positioning of the median arcuate ligament. […] Underlying Medical Conditions: Certain medical conditions, such as Marfan syndrome, Ehlers-Danlos syndrome, or fibromuscular dysplasia, may increase the risk of MALS due to their effects on connective tissue and vascular structure.
#122 Triad of MALS, Celiac Artery Dissection, and Fibrillin-1 Gene Variance of Unknown Significance | ACS
https://www.facs.org/for-medical-professionals/news-publications/journals/case-reviews/issues/v4n3/09-kirskey-triad-of-unknown-significance/
The diagnosis of MALS is ultimately achieved by a combination of duplex ultrasound, CTA, or MRA and correlating patient symptoms. […] Given her presentation and familial history, this patient underwent prior genetic workup due to high suspicion for a connective tissue disorder. […] We believe the widespread nature of spontaneous visceral arterial dissection in this patient, which included not only the celiac artery and its immediate branches but also spontaneous dissection of the right renal artery, could be reflective of genetic predisposition to arteriopathy secondary to fibrillin-1 gene variance. […] Our patient underwent median arcuate ligament release due to the presumptive diagnosis of MALS. […] In appropriate cases of MALS, minimally invasive median arcuate ligament release should be offered as it may improve vascular complications and patient symptoms.
#123 Median Arcuate Ligament Syndrome (MALS): Laparoscopic
https://www.laparoscopicsurgeons.com/blog/median-arcuate-ligament-syndrome-mals-signs-symptoms-causes.html
Median Arcuate Ligament Syndrome (MALS) is a rare and complex condition that affects the abdominal blood vessels. […] The primary cause of MALS is the compression or entrapment of the celiac artery by the median arcuate ligament. […] Several factors can contribute to the development of this condition: Anatomical Variations: Some individuals may have a naturally lower or more prominent median arcuate ligament, which increases the likelihood of celiac artery compression. […] Body Habitus: People with a thinner body type or a low percentage of body fat may be more prone to MALS due to the decreased cushioning around the abdominal structures. […] Age and Gender: MALS is more commonly diagnosed in young to middle-aged adults, with a higher prevalence among women. […] Trauma or Injury: Abdominal trauma or injury, such as from a car accident or sports-related incident, can lead to the development of MALS by altering the normal anatomy and positioning of the median arcuate ligament. […] Underlying Medical Conditions: Certain medical conditions, such as Marfan syndrome, Ehlers-Danlos syndrome, or fibromuscular dysplasia, may increase the risk of MALS due to their effects on connective tissue and vascular structure.
#124 Median Arcuate Ligament Syndrome (MALS): Laparoscopic
https://www.laparoscopicsurgeons.com/blog/median-arcuate-ligament-syndrome-mals-signs-symptoms-causes.html
Median Arcuate Ligament Syndrome (MALS) is a rare and complex condition that affects the abdominal blood vessels. […] The primary cause of MALS is the compression or entrapment of the celiac artery by the median arcuate ligament. […] Several factors can contribute to the development of this condition: Anatomical Variations: Some individuals may have a naturally lower or more prominent median arcuate ligament, which increases the likelihood of celiac artery compression. […] Body Habitus: People with a thinner body type or a low percentage of body fat may be more prone to MALS due to the decreased cushioning around the abdominal structures. […] Age and Gender: MALS is more commonly diagnosed in young to middle-aged adults, with a higher prevalence among women. […] Trauma or Injury: Abdominal trauma or injury, such as from a car accident or sports-related incident, can lead to the development of MALS by altering the normal anatomy and positioning of the median arcuate ligament. […] Underlying Medical Conditions: Certain medical conditions, such as Marfan syndrome, Ehlers-Danlos syndrome, or fibromuscular dysplasia, may increase the risk of MALS due to their effects on connective tissue and vascular structure.
#125 Triad of MALS, Celiac Artery Dissection, and Fibrillin-1 Gene Variance of Unknown Significance | ACS
https://www.facs.org/for-medical-professionals/news-publications/journals/case-reviews/issues/v4n3/09-kirskey-triad-of-unknown-significance/
The diagnosis of MALS is ultimately achieved by a combination of duplex ultrasound, CTA, or MRA and correlating patient symptoms. […] Given her presentation and familial history, this patient underwent prior genetic workup due to high suspicion for a connective tissue disorder. […] We believe the widespread nature of spontaneous visceral arterial dissection in this patient, which included not only the celiac artery and its immediate branches but also spontaneous dissection of the right renal artery, could be reflective of genetic predisposition to arteriopathy secondary to fibrillin-1 gene variance. […] Our patient underwent median arcuate ligament release due to the presumptive diagnosis of MALS. […] In appropriate cases of MALS, minimally invasive median arcuate ligament release should be offered as it may improve vascular complications and patient symptoms.
#126 Laparoscopic median arcuate ligament section for median arcuate ligament compression syndrome initially detected as splenic infarction: a case report | Surgical Case Reports | Full Text
https://surgicalcasereports.springeropen.com/articles/10.1186/s40792-024-01817-w
Median arcuate ligament compression syndrome (MALS) causes upper abdominal pain and at times hemodynamic abnormalities in the pancreaticoduodenal region. […] MALS may causes hemodynamic abnormalities including aneurysm rupture around the pancreaticoduodenal region. […] MALS is rarely detected in splenic infarction. […] In this case, median arcuate ligament compression syndrome caused splenic infarction by reducing blood flow to the splenic artery. […] MALS can cause hemodynamic abnormalities in the pancreaticoduodenal region. […] It has been reported that 6874% of patients with pancreaticoduodenal aneurysms have stenosis of the origin of the CA, and 80% of patients with stenosis of the origin of the CA have arterial dilatation of the pancreatic head arcade. […] Although splenic infarction due to decreased blood flow in the splenic artery is a rare complication in MALS, it should be kept in mind.
#127 Median Arcuate Ligament Syndrome: From Diagnosis to Multidisciplinary ManagementâA Narrative Review
https://www.mdpi.com/2813-2475/4/1/11
In addition, chronic compression of the CA by the MAL may promote the formation of aneurysms within the visceral arteries branching from the CA, such as aneurysms in the pancreatoduodenal artery arch. […] It is important to point out that in both paediatric and adult patients affected by MALS, psychiatric symptoms such as anxiety and depression are common. […] However, depression or anxiety may not disappear despite the resolution of symptoms in the post-operative period, so psychological care and the use of behavioral-cognitive therapy in such patients is extremely important.
#128 Laparoscopic median arcuate ligament section for median arcuate ligament compression syndrome initially detected as splenic infarction: a case report | Surgical Case Reports | Full Text
https://surgicalcasereports.springeropen.com/articles/10.1186/s40792-024-01817-w
Median arcuate ligament compression syndrome (MALS) causes upper abdominal pain and at times hemodynamic abnormalities in the pancreaticoduodenal region. […] MALS may causes hemodynamic abnormalities including aneurysm rupture around the pancreaticoduodenal region. […] MALS is rarely detected in splenic infarction. […] In this case, median arcuate ligament compression syndrome caused splenic infarction by reducing blood flow to the splenic artery. […] MALS can cause hemodynamic abnormalities in the pancreaticoduodenal region. […] It has been reported that 6874% of patients with pancreaticoduodenal aneurysms have stenosis of the origin of the CA, and 80% of patients with stenosis of the origin of the CA have arterial dilatation of the pancreatic head arcade. […] Although splenic infarction due to decreased blood flow in the splenic artery is a rare complication in MALS, it should be kept in mind.
#129 Laparoscopic median arcuate ligament section for median arcuate ligament compression syndrome initially detected as splenic infarction: a case report | Surgical Case Reports | Full Text
https://surgicalcasereports.springeropen.com/articles/10.1186/s40792-024-01817-w
Median arcuate ligament compression syndrome (MALS) causes upper abdominal pain and at times hemodynamic abnormalities in the pancreaticoduodenal region. […] MALS may causes hemodynamic abnormalities including aneurysm rupture around the pancreaticoduodenal region. […] MALS is rarely detected in splenic infarction. […] In this case, median arcuate ligament compression syndrome caused splenic infarction by reducing blood flow to the splenic artery. […] MALS can cause hemodynamic abnormalities in the pancreaticoduodenal region. […] It has been reported that 6874% of patients with pancreaticoduodenal aneurysms have stenosis of the origin of the CA, and 80% of patients with stenosis of the origin of the CA have arterial dilatation of the pancreatic head arcade. […] Although splenic infarction due to decreased blood flow in the splenic artery is a rare complication in MALS, it should be kept in mind.
#130 Triad of MALS, Celiac Artery Dissection, and Fibrillin-1 Gene Variance of Unknown Significance | ACS
https://www.facs.org/for-medical-professionals/news-publications/journals/case-reviews/issues/v4n3/09-kirskey-triad-of-unknown-significance/
Spontaneous celiac artery dissection is a rare vascular event with an unclear incidence. […] Two similarly rare conditions suggested to predispose individuals to celiac artery dissection are median arcuate ligament syndrome (MALS) and connective tissue disorders. […] We present a unique patient who had radiographic evidence of celiac artery dissection, sonographic evidence of increased arterial flow velocities in the setting of MALS, and an uncommon fibrillin gene variance likely manifesting as a predisposing collagen vascular disorder. […] Median arcuate ligament compression is present as a normal anatomic variation in a significant proportion of the population; therefore, a celiac plexus block can assist in confirming the diagnosis of MALS. […] Our patient’s symptoms were consistent with MALS.
#131 Triad of MALS, Celiac Artery Dissection, and Fibrillin-1 Gene Variance of Unknown Significance | ACS
https://www.facs.org/for-medical-professionals/news-publications/journals/case-reviews/issues/v4n3/09-kirskey-triad-of-unknown-significance/
The diagnosis of MALS is ultimately achieved by a combination of duplex ultrasound, CTA, or MRA and correlating patient symptoms. […] Given her presentation and familial history, this patient underwent prior genetic workup due to high suspicion for a connective tissue disorder. […] We believe the widespread nature of spontaneous visceral arterial dissection in this patient, which included not only the celiac artery and its immediate branches but also spontaneous dissection of the right renal artery, could be reflective of genetic predisposition to arteriopathy secondary to fibrillin-1 gene variance. […] Our patient underwent median arcuate ligament release due to the presumptive diagnosis of MALS. […] In appropriate cases of MALS, minimally invasive median arcuate ligament release should be offered as it may improve vascular complications and patient symptoms.
#132 Median Arcuate Ligament Syndrome | Lurie Children’s
https://www.luriechildrens.org/en/specialties-conditions/median-arcuate-ligament-syndrome/
Median arcuate ligament syndrome (also called celiac axis syndrome and Dunbar syndrome) is a rare condition resulting in symptoms of severe abdominal pain after eating, nausea, vomiting, and weight loss. […] It is caused by the squeezing of the celiac artery, the first major branch off the aorta as it runs from the heart down through the abdomen. […] But the syndrome is typically discovered by ruling out other causes such as peptic ulcer, gallbladder disease, appendicitis, inflammatory bowel disease, etc.
#133 Median arcuate ligament syndrome (MALS) – Hancock Health
https://www.hancockhealth.org/ja/mayo-health-library/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. […] The exact cause of median arcuate ligament syndrome, also called MALS, is not known. […] Because the cause of MALS is poorly understood, the risk factors are unclear. Median arcuate ligament syndrome is more common in adults than in children. It also is more common among women than among men. […] MALS also has been seen in identical twins, so genetics may play a role. […] Some people have developed median arcuate ligament syndrome after pancreatic surgery or blunt injury to the upper stomach area.
#134 Median arcuate ligament syndrome (MALS) – Hancock Health
https://www.hancockhealth.org/ja/mayo-health-library/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. […] The exact cause of median arcuate ligament syndrome, also called MALS, is not known. […] Because the cause of MALS is poorly understood, the risk factors are unclear. Median arcuate ligament syndrome is more common in adults than in children. It also is more common among women than among men. […] MALS also has been seen in identical twins, so genetics may play a role. […] Some people have developed median arcuate ligament syndrome after pancreatic surgery or blunt injury to the upper stomach area.
#135 Celiac Artery Compression Syndrome – StatPearls – NCBI Bookshelf
https://www.ncbi.nlm.nih.gov/books/NBK470601/
Celiac artery compression syndrome is also known as Dunbar syndrome or median arcuate ligament syndrome. It is a rare condition characterized by recurrent abdominal pain that results from compression of the celiac artery. Compression is due to the presence of a fibrous band of the diaphragm known as the median arcuate ligament. […] The etiology of celiac artery compression syndrome is not fully understood. Uncertainty arises because the anatomic compression of the celiac artery by the median arcuate ligament can also be seen in asymptomatic patients. In other words, every patient with this anatomic compression does not develop symptoms. The median arcuate ligament is a fibrous band that connects the two medial borders of the diaphragmatic crura, usually near the level of the 12th thoracic or first lumbar vertebra. Compression of the celiac artery can occur in two anatomic situations: an abnormally cephalad origin of the celiac artery or an abnormally caudad insertion of the diaphragm. Congenital factors may influence the level of the insertion of the diaphragm or the origin of the celiac artery. This hypothesis is supported by a small series of studies in families and monozygotic twins. The compression of the celiac artery by the median arcuate ligament is believed to cause intermittent mesenteric ischemia. However, this explanation alone may not completely explain the condition as there is usually a rich collateral network of mesenteric vessels between the celiac artery and the superior mesenteric artery. Therefore, there may be a role for underlying celiac nerve plexus dysfunction as well when considering the etiology of this condition. Nerve dysfunction may lead to abnormal splanchnic vasoconstriction, leading to ischemia.
#136 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. […] The etiology and pathophysiology of MALS remain poorly understood but are believed to involve both ischemic and neuropathic components. […] Median arcuate ligament syndrome is a rare cause of chronic abdominal pain that poses a diagnostic challenge, particularly in pediatric patients. […] Vascular etiologies such as MALS should be considered when previous workup and management have failed to provide a definitive diagnosis.
#137
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. […] The location of the median arcuate ligament and celiac artery varies slightly from person to person. Typically, the ligament runs across the largest blood vessel in the body (aorta). It sits above the celiac artery. But sometimes the ligament or artery may be out of place, causing MALS. The ligament may also put pressure on the network of nerves surrounding the celiac artery (celiac plexus). […] Doctors aren’t exactly sure what causes median arcuate ligament syndrome. The causes and diagnosis of MALS are a subject of controversy. […] Because the cause of MALS is poorly understood, the risk factors for the syndrome are unclear. MALS has been seen in children, even twins, which might mean genetics plays a role. […] Some people have developed MALS after pancreatic surgery and blunt injury to the upper stomach area.
#138 âUnderstanding Median Arcuate Ligament Syndrome (MALS): Causes, Symptoms, and Treatmentâ
https://www.doctorshubnepal.com/diseases-conditions/median-arcuate-ligament-syndrome-mals
Median Arcuate Ligament Syndrome (MALS), also known as celiac artery compression syndrome, is a rare vascular disorder. […] The exact cause of MALS remains controversial, but several factors may contribute: […] A low-lying median arcuate ligament can compress the celiac axis, leading to MALS. […] Although poorly understood, genetics may play a role, as MALS has been observed in twins and family members. […] Some individuals develop MALS after pancreatic surgery. […] Blunt injury to the upper abdomen may trigger MALS. […] While the precise risk factors are unclear, the following factors may increase the likelihood of developing MALS: […] MALS is more common in younger individuals, typically between 20 and 50 years old. […] Women are often affected, especially those aged 20 to 40.
#139 Overview of Median Arcuate Ligament Syndrome: A Narrative Review
https://pmc.ncbi.nlm.nih.gov/articles/PMC10629207/
The diagnosis of MALS is a diagnosis of exclusion. […] Since MALS is caused by compression of the celiac artery by the MAL, treatment for this disorder is centered around decompression of the celiac artery. […] Surgical intervention aims to carry out the complete division of overlying tissue from the diaphragmatic crura, which forms the MAL, along with potential neurolysis of the celiac plexus nerve fibers to aid in pain relief. […] Additional procedures such as revascularization of the celiac artery by stenting, celiac artery bypass surgery, and celiac ablation can be done if stenosis persists after MAL decompression. […] Median arcuate ligament syndrome is a rare disorder that is often difficult to recognize in patients who present with this condition. […] This disorder is believed to be caused primarily by compression of the celiac plexus and celiac artery by the MAL.
#140 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
It is thought that the compression of the coeliac artery can cause foregut pain and ischaemia during increased demand when patients eat. […] Some postulate that a steal phenomenon occurs due to significant collateral circulation causing blood to be diverted away from the midgut to the foregut following meals, resulting in midgut ischaemia and pain. […] Further theories include that overstimulation of the coeliac plexus causes significant vasoconstriction, which results in ischaemic abdominal pain and the entrapment of the coeliac ganglion, altering gastric myoelectrical activity, impairing antral motility and causing neurogenic pain. […] The prevalence of MALS remains unclear, which is partly due to its variable clinical presentation. […] MALS occurs most commonly in young women. […] MALS does not have universally accepted diagnostic criteria.
#141 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
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. […] 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. […] Unlike chronic mesenteric ischaemia caused by atherosclerosis, antiplatelet and cholesterol lowering tablets are not usually indicated for MALS. […] MALS is a rare cause of abdominal pain that lacks defined diagnostic criteria. […] Those affected by MALS are often young, and it can cause significant morbidity. […] The pathophysiology of MALS is unclear but is likely an interplay between coeliac artery and coeliac ganglion compression.
#142 Overview of Median Arcuate Ligament Syndrome: A Narrative Review
https://pmc.ncbi.nlm.nih.gov/articles/PMC10629207/
The diagnosis of MALS is a diagnosis of exclusion. […] Since MALS is caused by compression of the celiac artery by the MAL, treatment for this disorder is centered around decompression of the celiac artery. […] Surgical intervention aims to carry out the complete division of overlying tissue from the diaphragmatic crura, which forms the MAL, along with potential neurolysis of the celiac plexus nerve fibers to aid in pain relief. […] Additional procedures such as revascularization of the celiac artery by stenting, celiac artery bypass surgery, and celiac ablation can be done if stenosis persists after MAL decompression. […] Median arcuate ligament syndrome is a rare disorder that is often difficult to recognize in patients who present with this condition. […] This disorder is believed to be caused primarily by compression of the celiac plexus and celiac artery by the MAL.
#143 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
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. […] 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. […] Unlike chronic mesenteric ischaemia caused by atherosclerosis, antiplatelet and cholesterol lowering tablets are not usually indicated for MALS. […] MALS is a rare cause of abdominal pain that lacks defined diagnostic criteria. […] Those affected by MALS are often young, and it can cause significant morbidity. […] The pathophysiology of MALS is unclear but is likely an interplay between coeliac artery and coeliac ganglion compression.
#144 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. […] This is known as median arcuate ligament syndrome (MALS). This condition is also known as celiac artery compression syndrome, Dunbar syndrome, or Harjola-Marable syndrome. […] Abnormally low insertion of this ligament can lead to MALS. […] The suffered group is usually young lean females between the age of 30 and 50 years and present with abdominal pain. […] 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. […] Conventional catheter angiography was the imaging modality of the choice for MALS in the past. […] Surgical median arcuate ligament release has been the mainstay of treatment.
#145 Median Arcuate Ligament Syndrome | Lurie Children’s
https://www.luriechildrens.org/en/specialties-conditions/median-arcuate-ligament-syndrome/
Median arcuate ligament syndrome (also called celiac axis syndrome and Dunbar syndrome) is a rare condition resulting in symptoms of severe abdominal pain after eating, nausea, vomiting, and weight loss. […] It is caused by the squeezing of the celiac artery, the first major branch off the aorta as it runs from the heart down through the abdomen. […] But the syndrome is typically discovered by ruling out other causes such as peptic ulcer, gallbladder disease, appendicitis, inflammatory bowel disease, etc.
#146 Median Arcuate Ligament Syndrome | Lurie Children’s
https://www.luriechildrens.org/en/specialties-conditions/median-arcuate-ligament-syndrome/
Median arcuate ligament syndrome (also called celiac axis syndrome and Dunbar syndrome) is a rare condition resulting in symptoms of severe abdominal pain after eating, nausea, vomiting, and weight loss. […] It is caused by the squeezing of the celiac artery, the first major branch off the aorta as it runs from the heart down through the abdomen. […] But the syndrome is typically discovered by ruling out other causes such as peptic ulcer, gallbladder disease, appendicitis, inflammatory bowel disease, etc.
#147 Median Arcuate Ligament Syndrome | Lurie Children’s
https://www.luriechildrens.org/en/specialties-conditions/median-arcuate-ligament-syndrome/
Median arcuate ligament syndrome (also called celiac axis syndrome and Dunbar syndrome) is a rare condition resulting in symptoms of severe abdominal pain after eating, nausea, vomiting, and weight loss. […] It is caused by the squeezing of the celiac artery, the first major branch off the aorta as it runs from the heart down through the abdomen. […] But the syndrome is typically discovered by ruling out other causes such as peptic ulcer, gallbladder disease, appendicitis, inflammatory bowel disease, etc.
#148 Median Arcuate Ligament Syndrome | Lurie Children’s
https://www.luriechildrens.org/en/specialties-conditions/median-arcuate-ligament-syndrome/
Median arcuate ligament syndrome (also called celiac axis syndrome and Dunbar syndrome) is a rare condition resulting in symptoms of severe abdominal pain after eating, nausea, vomiting, and weight loss. […] It is caused by the squeezing of the celiac artery, the first major branch off the aorta as it runs from the heart down through the abdomen. […] But the syndrome is typically discovered by ruling out other causes such as peptic ulcer, gallbladder disease, appendicitis, inflammatory bowel disease, etc.
#149 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. […] This is known as median arcuate ligament syndrome (MALS). This condition is also known as celiac artery compression syndrome, Dunbar syndrome, or Harjola-Marable syndrome. […] Abnormally low insertion of this ligament can lead to MALS. […] The suffered group is usually young lean females between the age of 30 and 50 years and present with abdominal pain. […] 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. […] Conventional catheter angiography was the imaging modality of the choice for MALS in the past. […] Surgical median arcuate ligament release has been the mainstay of treatment.
#150 Median Arcuate Ligament Syndrome | Applied Radiology
https://appliedradiology.com/articles/median-arcuate-ligament-syndrome
Median arcuate ligament syndrome (MALS), also known as Dunbar Syndrome, is an uncommon condition where the MAL compresses the celiac trunk. […] The condition was first discovered in 1917 by Benjamin Lipshutz while dissecting cadavers; he noted the MAL overlapping and compressing the celiac artery. […] In patients with MALS, the ligament is lower than normal, compressing the celiac trunk and reducing blood flow to the abdominal organs, especially the stomach and liver. […] This hypoperfusion leads to many of the manifestations of MALS, which may rarely even include necrosis of the stomach and liver if left untreated. […] The pain is believed to be caused by compression of the celiac plexus, the collection of nerves located directly over the celiac artery. […] Other common etiologies such as GERD, gastritis, and Crohn disease must first be excluded before MALS can be diagnosed.
#151 Median Arcuate Ligament Syndrome | Applied Radiology
https://appliedradiology.com/articles/median-arcuate-ligament-syndrome
Median arcuate ligament syndrome (MALS), also known as Dunbar Syndrome, is an uncommon condition where the MAL compresses the celiac trunk. […] The condition was first discovered in 1917 by Benjamin Lipshutz while dissecting cadavers; he noted the MAL overlapping and compressing the celiac artery. […] In patients with MALS, the ligament is lower than normal, compressing the celiac trunk and reducing blood flow to the abdominal organs, especially the stomach and liver. […] This hypoperfusion leads to many of the manifestations of MALS, which may rarely even include necrosis of the stomach and liver if left untreated. […] The pain is believed to be caused by compression of the celiac plexus, the collection of nerves located directly over the celiac artery. […] Other common etiologies such as GERD, gastritis, and Crohn disease must first be excluded before MALS can be diagnosed.
#152 Median arcuate ligament syndrome – Wikipedia
https://en.wikipedia.org/wiki/Median_arcuate_ligament_syndrome
Median arcuate ligament syndrome results from compression of the celiac artery by the median arcuate ligament. […] The median arcuate ligament syndrome (MALS, also known as celiac artery compression syndrome) is a rare condition characterized by abdominal pain attributed to compression of the celiac artery and the celiac ganglia by the median arcuate ligament. […] In some of these individuals, this compression is pathologic and leads to the median arcuate ligament syndrome. […] Several theories attempt to explain the origin of pain caused by compression of the celiac artery. […] The diagnosis of MALS relies on a combination of clinical features and findings on medical imaging. […] Proximal celiac artery stenosis with poststenotic dilatation can be seen in other conditions affecting the celiac artery.
#153
https://journals.lww.com/ajg/fulltext/2023/10001/s4245_a_rare_cause_of_abdominal_pain__median.4243.aspx
Median arcuate ligament syndrome (MALS), also known as celiac artery compression or Dunbar syndrome, is a rare condition with an incidence of 2 per 100,000 patients involving compression of the celiac artery by the median arcuate ligament. […] MRA of the abdomen and pelvis revealed narrowing of celiac artery with a J-shaped appearance at the level of the median arcuate ligament with post stenotic dilatation consistent with MALS. […] MALS is more prevalent in women with a thin body habitus between the ages of 40 and 60. […] Diagnosis involves vascular imaging and oftentimes combined duplex ultrasound with respiratory maneuvers. […] Treatment involves a laparoscopic approach of celiac artery decompression and celiac ganglionectomy or neurolysis concurrently to address the neuropathic component. […] Clinicians should consider MALS in the evaluation of chronic abdominal pain and weight loss and recognize this rare phenomenon.
#154 Triad of MALS, Celiac Artery Dissection, and Fibrillin-1 Gene Variance of Unknown Significance | ACS
https://www.facs.org/for-medical-professionals/news-publications/journals/case-reviews/issues/v4n3/09-kirskey-triad-of-unknown-significance/
The diagnosis of MALS is ultimately achieved by a combination of duplex ultrasound, CTA, or MRA and correlating patient symptoms. […] Given her presentation and familial history, this patient underwent prior genetic workup due to high suspicion for a connective tissue disorder. […] We believe the widespread nature of spontaneous visceral arterial dissection in this patient, which included not only the celiac artery and its immediate branches but also spontaneous dissection of the right renal artery, could be reflective of genetic predisposition to arteriopathy secondary to fibrillin-1 gene variance. […] Our patient underwent median arcuate ligament release due to the presumptive diagnosis of MALS. […] In appropriate cases of MALS, minimally invasive median arcuate ligament release should be offered as it may improve vascular complications and patient symptoms.
#155 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. […] Severe stenosis of the celiac artery is predicted to affect 1% of patients with imaging findings of MALS. […] Recognition of MALS as a potential etiology in the diagnostic evaluation of abdominal pain is of growing clinical importance. […] Increased bariatric surgery incidence leads to a higher prevalence of patients with rapid weight loss: a major risk factor for the development of MALS. […] The celiac nerve plexus impingement in MALS can lead to a broad distribution of abdominal pain, such as further hepatic, gastric, splenic, and pancreatic plexuses. […] However, challenges in diagnosis include the nonspecific symptoms seen in the triad commonly associated with MALS: epigastric pain, weight loss, and abdominal bruit. […] Doppler vascular ultrasound to evaluate respiratory variation can help determine if compression is clinically significant and may be contributing to abdominal pain.
#156 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. […] This is known as median arcuate ligament syndrome (MALS). This condition is also known as celiac artery compression syndrome, Dunbar syndrome, or Harjola-Marable syndrome. […] Abnormally low insertion of this ligament can lead to MALS. […] The suffered group is usually young lean females between the age of 30 and 50 years and present with abdominal pain. […] 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. […] Conventional catheter angiography was the imaging modality of the choice for MALS in the past. […] Surgical median arcuate ligament release has been the mainstay of treatment.
#157 Triad of MALS, Celiac Artery Dissection, and Fibrillin-1 Gene Variance of Unknown Significance | ACS
https://www.facs.org/for-medical-professionals/news-publications/journals/case-reviews/issues/v4n3/09-kirskey-triad-of-unknown-significance/
The diagnosis of MALS is ultimately achieved by a combination of duplex ultrasound, CTA, or MRA and correlating patient symptoms. […] Given her presentation and familial history, this patient underwent prior genetic workup due to high suspicion for a connective tissue disorder. […] We believe the widespread nature of spontaneous visceral arterial dissection in this patient, which included not only the celiac artery and its immediate branches but also spontaneous dissection of the right renal artery, could be reflective of genetic predisposition to arteriopathy secondary to fibrillin-1 gene variance. […] Our patient underwent median arcuate ligament release due to the presumptive diagnosis of MALS. […] In appropriate cases of MALS, minimally invasive median arcuate ligament release should be offered as it may improve vascular complications and patient symptoms.
#158 Median arcuate ligament syndrome – Wikipedia
https://en.wikipedia.org/wiki/Median_arcuate_ligament_syndrome
The hook-shaped contour of the celiac artery is characteristic of the anatomy in MALS and helps distinguish it from other causes of celiac artery stenosis such as atherosclerosis. […] Decompression of the celiac artery is the general approach to treatment of MALS. […] The syndrome most commonly affects individuals between 20 and 40 years old, and is more common in women, particularly thin women.
#159
https://journals.lww.com/ajg/fulltext/2023/10001/s4245_a_rare_cause_of_abdominal_pain__median.4243.aspx
Median arcuate ligament syndrome (MALS), also known as celiac artery compression or Dunbar syndrome, is a rare condition with an incidence of 2 per 100,000 patients involving compression of the celiac artery by the median arcuate ligament. […] MRA of the abdomen and pelvis revealed narrowing of celiac artery with a J-shaped appearance at the level of the median arcuate ligament with post stenotic dilatation consistent with MALS. […] MALS is more prevalent in women with a thin body habitus between the ages of 40 and 60. […] Diagnosis involves vascular imaging and oftentimes combined duplex ultrasound with respiratory maneuvers. […] Treatment involves a laparoscopic approach of celiac artery decompression and celiac ganglionectomy or neurolysis concurrently to address the neuropathic component. […] Clinicians should consider MALS in the evaluation of chronic abdominal pain and weight loss and recognize this rare phenomenon.
#160 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. […] This is known as median arcuate ligament syndrome (MALS). This condition is also known as celiac artery compression syndrome, Dunbar syndrome, or Harjola-Marable syndrome. […] Abnormally low insertion of this ligament can lead to MALS. […] The suffered group is usually young lean females between the age of 30 and 50 years and present with abdominal pain. […] 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. […] Conventional catheter angiography was the imaging modality of the choice for MALS in the past. […] Surgical median arcuate ligament release has been the mainstay of treatment.
#161 Median Arcuate Ligament Syndrome Clinical Presentation, Pathophysiology, and Management: Description of Four Cases
https://www.mdpi.com/2624-5647/3/1/5
The major findings specific for the diagnosis are compression of the celiac artery with respiratory variations, post-compression dilation, and elevated velocities of blood flow. […] The definitive treatment is the surgical release of the median arcuate ligament to achieve decompression of the celiac plexus. […] Intraoperative pre- and post-decompression flow velocity studies are performed routinely to assess success of the procedure. […] 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.
#162 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
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. […] 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. […] Unlike chronic mesenteric ischaemia caused by atherosclerosis, antiplatelet and cholesterol lowering tablets are not usually indicated for MALS. […] MALS is a rare cause of abdominal pain that lacks defined diagnostic criteria. […] Those affected by MALS are often young, and it can cause significant morbidity. […] The pathophysiology of MALS is unclear but is likely an interplay between coeliac artery and coeliac ganglion compression.
#163 Triad of MALS, Celiac Artery Dissection, and Fibrillin-1 Gene Variance of Unknown Significance | ACS
https://www.facs.org/for-medical-professionals/news-publications/journals/case-reviews/issues/v4n3/09-kirskey-triad-of-unknown-significance/
Spontaneous celiac artery dissection is a rare vascular event with an unclear incidence. […] Two similarly rare conditions suggested to predispose individuals to celiac artery dissection are median arcuate ligament syndrome (MALS) and connective tissue disorders. […] We present a unique patient who had radiographic evidence of celiac artery dissection, sonographic evidence of increased arterial flow velocities in the setting of MALS, and an uncommon fibrillin gene variance likely manifesting as a predisposing collagen vascular disorder. […] Median arcuate ligament compression is present as a normal anatomic variation in a significant proportion of the population; therefore, a celiac plexus block can assist in confirming the diagnosis of MALS. […] Our patient’s symptoms were consistent with MALS.
#164 Triad of MALS, Celiac Artery Dissection, and Fibrillin-1 Gene Variance of Unknown Significance | ACS
https://www.facs.org/for-medical-professionals/news-publications/journals/case-reviews/issues/v4n3/09-kirskey-triad-of-unknown-significance/
Spontaneous celiac artery dissection is a rare vascular event with an unclear incidence. […] Two similarly rare conditions suggested to predispose individuals to celiac artery dissection are median arcuate ligament syndrome (MALS) and connective tissue disorders. […] We present a unique patient who had radiographic evidence of celiac artery dissection, sonographic evidence of increased arterial flow velocities in the setting of MALS, and an uncommon fibrillin gene variance likely manifesting as a predisposing collagen vascular disorder. […] Median arcuate ligament compression is present as a normal anatomic variation in a significant proportion of the population; therefore, a celiac plexus block can assist in confirming the diagnosis of MALS. […] Our patient’s symptoms were consistent with MALS.
#165 A Median Arcuate Ligament Syndrome Could Be Re-termed as a Nutcracker Celiac Ganglion Abdominal Pain Syndrome
https://www.jnmjournal.org/journal/view.html?volume=29&number=2&spage=200
NCGAPS is overlooked as a cause of abdominal pain because it is still considered a very rare disease and the mechanism is unclear. […] Our study suggests a diagnostic process of abdominal pain of unknown etiology. First, exclude organic GI disease by abdomen and pelvis CT scan and esophagogastroduodenoscopy. After excluding the problem of organic GI disease, listen to patients symptoms in detail, such as pain alleviated with positional change/deep inspiration or pain not associated with meals and defecation. […] We suggest renaming the name of MALS as NCGAPS, nutcracker celiac ganglion abdominal pain syndrome, to better explain the mechanism of the recurrent abdominal pain and to raise awareness of the cause of the pain.
#166 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
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. […] 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. […] Unlike chronic mesenteric ischaemia caused by atherosclerosis, antiplatelet and cholesterol lowering tablets are not usually indicated for MALS. […] MALS is a rare cause of abdominal pain that lacks defined diagnostic criteria. […] Those affected by MALS are often young, and it can cause significant morbidity. […] The pathophysiology of MALS is unclear but is likely an interplay between coeliac artery and coeliac ganglion compression.
#167 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
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. […] 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. […] Unlike chronic mesenteric ischaemia caused by atherosclerosis, antiplatelet and cholesterol lowering tablets are not usually indicated for MALS. […] MALS is a rare cause of abdominal pain that lacks defined diagnostic criteria. […] Those affected by MALS are often young, and it can cause significant morbidity. […] The pathophysiology of MALS is unclear but is likely an interplay between coeliac artery and coeliac ganglion compression.
#168 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
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. […] 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. […] Unlike chronic mesenteric ischaemia caused by atherosclerosis, antiplatelet and cholesterol lowering tablets are not usually indicated for MALS. […] MALS is a rare cause of abdominal pain that lacks defined diagnostic criteria. […] Those affected by MALS are often young, and it can cause significant morbidity. […] The pathophysiology of MALS is unclear but is likely an interplay between coeliac artery and coeliac ganglion compression.
#169 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
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. […] 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. […] Unlike chronic mesenteric ischaemia caused by atherosclerosis, antiplatelet and cholesterol lowering tablets are not usually indicated for MALS. […] MALS is a rare cause of abdominal pain that lacks defined diagnostic criteria. […] Those affected by MALS are often young, and it can cause significant morbidity. […] The pathophysiology of MALS is unclear but is likely an interplay between coeliac artery and coeliac ganglion compression.
#170 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
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. […] 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. […] Unlike chronic mesenteric ischaemia caused by atherosclerosis, antiplatelet and cholesterol lowering tablets are not usually indicated for MALS. […] MALS is a rare cause of abdominal pain that lacks defined diagnostic criteria. […] Those affected by MALS are often young, and it can cause significant morbidity. […] The pathophysiology of MALS is unclear but is likely an interplay between coeliac artery and coeliac ganglion compression.
#171 Median arcuate ligament syndrome (Dunbar syndrome) – Iqbal – Cardiovascular Diagnosis and Therapy
https://cdt.amegroups.org/article/view/67298/html
Median arcuate ligament syndrome (MALS) is a rare condition which is due to the compression of celiac trunk by low riding of fibrous attachments of median arcuate ligament and diaphragmatic crura. […] The higher origin of celiac artery or lower insertion of diaphragmatic crura are likely to lead to MALS. […] Sometimes median arcuate ligament crosses the lower abdominal aorta causing compression. […] Compression can be due to thick, fibrous tissue or thin bands at or near the origin of celiac artery. […] The treatment of MALS aims at decompression of celiac artery to establish adequate blood flow and pain management by neurolysis. […] The neuropathic pain of MALS can be addressed with removal or ablation of ganglion and celiac artery revascularization. […] The role of intervention radiology is emerging in the treatment of MALS, though its outcomes are not promising. […] This may be due to the extrinsic compression of celiac artery causing intimal hyperplasia resulting luminal narrowing of artery. […] However, further definitive studies are needed to address the pathophysiology, better diagnose and devise minimally invasive treatment for this entity.
#172 Median Arcuate Ligament Syndrome: From Diagnosis to Multidisciplinary ManagementâA Narrative Review
https://www.mdpi.com/2813-2475/4/1/11
In addition, chronic compression of the CA by the MAL may promote the formation of aneurysms within the visceral arteries branching from the CA, such as aneurysms in the pancreatoduodenal artery arch. […] It is important to point out that in both paediatric and adult patients affected by MALS, psychiatric symptoms such as anxiety and depression are common. […] However, depression or anxiety may not disappear despite the resolution of symptoms in the post-operative period, so psychological care and the use of behavioral-cognitive therapy in such patients is extremely important.
#173 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
Surgery is the only treatment for median arcuate ligament syndrome, also called MALS. Surgery for MALS can improve or reduce symptoms in most people. […] The most common surgical treatment is median arcuate ligament release, also called decompression. […] During decompression surgery, the surgeon cuts away parts of the median arcuate ligament. This reduces pressure on the celiac artery and nerves. […] Some people with MALS also may need surgery to repair or replace a blocked celiac artery and restore blood flow. […] Median arcuate ligament syndrome (MALS) care at Mayo Clinic. […] Median arcuate ligament syndrome: Pathophysiology, diagnosis, and management. […] Celiac artery compression syndrome. […] Under pressure: A head-to-toe review of vascular compression syndromes. […] Median arcuate ligament syndrome. […] Factors associated with successful median arcuate ligament release in an international, multi-institutional cohort. […] Systematic review of the efficacy of treatment for median arcuate ligament syndrome.
#174 Is MALS Curable? Median Arcuate Ligament Syndrome
https://www.medicinenet.com/is_mals_curable/article.htm
Median arcuate ligament syndrome (MALS) is an anatomical abnormality caused by the median arcuate ligament compressing the celiac plexus nerves over the celiac artery in the abdomen. The compression of these nerves can cause significant pain. […] Another cause of MALS may be due to the lack of blood flow to the organs supplied by the celiac artery, although this is a controversial theory. […] Median arcuate ligament syndrome can be cured with surgery, which is the only treatment option currently available. The most common surgery performed is called median arcuate ligament release or median arcuate ligament decompression, which is an open surgery but can also be done with minimally invasive techniques using laparoscopy or robotics.
#175 Median Arcuate Ligament Syndrome (MALS)
https://www.webmd.com/digestive-disorders/median-arcuate-ligament-syndrome-overview
When you have MALS, this ligament sits lower than usual and presses on the celiac artery. This blood vessel delivers blood to the stomach, liver, and other organs in your belly. […] It’s the pressure from the ligament that causes trouble. It may slow blood flow to the organs in your belly and press on nerves around the artery. Both can cause pain. […] The main treatment for MALS is surgery to release the pressure that the median arcuate ligament puts on your artery.
#176 Overview of Median Arcuate Ligament Syndrome: A Narrative Review
https://pmc.ncbi.nlm.nih.gov/articles/PMC10629207/
Median arcuate ligament syndrome (MALS) is a rare disorder caused primarily by compression of the celiac trunk by the median arcuate ligament (MAL). […] It is believed to be caused by the constriction of the celiac artery and the celiac plexus by the median arcuate ligament (MAL). […] While the reason for this anatomical malformation is unknown, it is believed that both hereditary and environmental factors likely play a role in the development of MALS. […] Due to this abnormal anatomical structure, the celiac artery and the celiac plexus are compressed by the MAL. […] This compression may result in hyperplasia of the intimal wall of the celiac artery, thus causing stenosis of its lumen and ultimately resulting in ischemia of the abdominal organs. […] The symptoms of MALS are believed to be due to the abnormally low insertion of the MAL, which occurs because of errors in embryological development.
#177 Overview of Median Arcuate Ligament Syndrome: A Narrative Review
https://pmc.ncbi.nlm.nih.gov/articles/PMC10629207/
The diagnosis of MALS is a diagnosis of exclusion. […] Since MALS is caused by compression of the celiac artery by the MAL, treatment for this disorder is centered around decompression of the celiac artery. […] Surgical intervention aims to carry out the complete division of overlying tissue from the diaphragmatic crura, which forms the MAL, along with potential neurolysis of the celiac plexus nerve fibers to aid in pain relief. […] Additional procedures such as revascularization of the celiac artery by stenting, celiac artery bypass surgery, and celiac ablation can be done if stenosis persists after MAL decompression. […] Median arcuate ligament syndrome is a rare disorder that is often difficult to recognize in patients who present with this condition. […] This disorder is believed to be caused primarily by compression of the celiac plexus and celiac artery by the MAL.
#178 Median arcuate ligament syndrome – UpToDate
https://www.uptodate.com/contents/median-arcuate-ligament-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. […] The etiology and pathophysiology of MALS are incompletely understood but may be related to both ischemic and neuropathic mechanisms. […] A subset of patients (approximately 10 percent) has an abnormally positioned median arcuate ligament that appears to compress an otherwise normally positioned celiac artery. […] 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.
#179 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
It is thought that the compression of the coeliac artery can cause foregut pain and ischaemia during increased demand when patients eat. […] Some postulate that a steal phenomenon occurs due to significant collateral circulation causing blood to be diverted away from the midgut to the foregut following meals, resulting in midgut ischaemia and pain. […] Further theories include that overstimulation of the coeliac plexus causes significant vasoconstriction, which results in ischaemic abdominal pain and the entrapment of the coeliac ganglion, altering gastric myoelectrical activity, impairing antral motility and causing neurogenic pain. […] The prevalence of MALS remains unclear, which is partly due to its variable clinical presentation. […] MALS occurs most commonly in young women. […] MALS does not have universally accepted diagnostic criteria.
#180 Median arcuate ligament syndrome: Incidental finding or real problem? | Cleveland Clinic Journal of Medicine
https://www.ccjm.org/content/88/3/140
Median arcuate ligament syndrome, 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. […] Theories regarding the pathophysiology of epigastric pain associated with MALS include foregut ischemia due to compressed celiac artery, midgut ischemia due to vascular steal syndrome, and overstimulation of the celiac plexus with subsequent splanchnic vasoconstriction and ischemia. Recently, ideas about the etiology of MALS have shifted from its being a vascular disease to a neurogenic disorder with compression of the surrounding celiac plexus and ganglion. […] Anatomically, up to 24% of the population may have compression of the celiac artery; however, fewer than 1% of them have symptoms.
#181 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. […] Because the median arcuate ligament is compressing both the celiac artery and the celiac ganglion nerves, there is debate as to whether the cause of pain is ischemic (caused by blood flow) or neurogenic (caused by the nerves). […] Many doctors believe MALS is a vascular issue however, this does not explain the pain patients feel, nor does it address those patients who continue to suffer despite having adequate blood flow through the celiac artery. […] Those who believe MALS is a neurologic issue focus on the celiac ganglion as the main cause of a patients symptoms. Because of the pressure on the nerves, they have become inflamed beyond the point of repair. These inflamed nerves must be addressed to resolve the patients disabling pain.
#182 Median arcuate ligament syndrome (MALS) – Symptoms and causes – Mayo Clinic
https://www.mayoclinic.org/diseases-conditions/median-arcuate-ligament-syndrome-mals/symptoms-causes/syc-20505001
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. […] The exact cause of median arcuate ligament syndrome, also called MALS, is not known. […] Because the cause of MALS is poorly understood, the risk factors are unclear. Median arcuate ligament syndrome is more common in adults than in children. It also is more common among women than among men. […] Some people have developed median arcuate ligament syndrome after pancreatic surgery or blunt injury to the upper stomach area.
#183 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. […] The primary cause of MALS is the anatomical compression of the celiac artery by the median arcuate ligament. This fibrous band usually sits above the artery but can sometimes position itself lower than usual, pressing against the artery and surrounding nerves, such as the celiac plexus and celiac ganglion. […] Several factors can increase the risk of developing MALS, including: Rapid Weight Loss: Loss of the protective fat pad surrounding the artery can increase the likelihood of compression. Anatomical Variations: Individuals with specific anatomical configurations, like the median arcuate ligament muscle and fibers, are more prone to MALS. Demographics: MALS most commonly affects women, particularly those between the ages of 20 and 40. Conditions like Dunbar Syndrome may also be associated with MALS.
#184 Median arcuate ligament syndrome – Wikipedia
https://en.wikipedia.org/wiki/Median_arcuate_ligament_syndrome
The hook-shaped contour of the celiac artery is characteristic of the anatomy in MALS and helps distinguish it from other causes of celiac artery stenosis such as atherosclerosis. […] Decompression of the celiac artery is the general approach to treatment of MALS. […] The syndrome most commonly affects individuals between 20 and 40 years old, and is more common in women, particularly thin women.
#185 Overview of Median Arcuate Ligament Syndrome: A Narrative Review
https://pmc.ncbi.nlm.nih.gov/articles/PMC10629207/
The diagnosis of MALS is a diagnosis of exclusion. […] Since MALS is caused by compression of the celiac artery by the MAL, treatment for this disorder is centered around decompression of the celiac artery. […] Surgical intervention aims to carry out the complete division of overlying tissue from the diaphragmatic crura, which forms the MAL, along with potential neurolysis of the celiac plexus nerve fibers to aid in pain relief. […] Additional procedures such as revascularization of the celiac artery by stenting, celiac artery bypass surgery, and celiac ablation can be done if stenosis persists after MAL decompression. […] Median arcuate ligament syndrome is a rare disorder that is often difficult to recognize in patients who present with this condition. […] This disorder is believed to be caused primarily by compression of the celiac plexus and celiac artery by the MAL.
#186 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
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. […] 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. […] Unlike chronic mesenteric ischaemia caused by atherosclerosis, antiplatelet and cholesterol lowering tablets are not usually indicated for MALS. […] MALS is a rare cause of abdominal pain that lacks defined diagnostic criteria. […] Those affected by MALS are often young, and it can cause significant morbidity. […] The pathophysiology of MALS is unclear but is likely an interplay between coeliac artery and coeliac ganglion compression.
#187 Median Arcuate Ligament Syndrome: A Cause of Postprandial Abdominal Pain in a Patient With Ulcerative Colitis | Hill | Journal of Medical Cases
https://www.journalmc.org/index.php/JMC/article/view/1773/1147
Median arcuate ligament syndrome (MALS) is a condition caused by the external compression of the celiac artery by the median arcuate ligament. […] The pathophysiology of the pain is debated between ischemia due to celiac artery compression and neurogenic disturbance from celiac plexus compression. […] MALS has been linked to the development of other gastrointestinal disorders such as gastroparesis. […] The goal of treatment of MALS is restoring normal blood flow in the celiac axis. […] The consequence of chronic celiac trunk compression is unknown. […] Additionally, it provokes the question of whether MALS can lead to other abdominal pathologies.
#188 Median arcuate ligament syndrome (Dunbar syndrome) – Iqbal – Cardiovascular Diagnosis and Therapy
https://cdt.amegroups.org/article/view/67298/html
Median arcuate ligament syndrome (MALS) is a rare condition which is due to the compression of celiac trunk by low riding of fibrous attachments of median arcuate ligament and diaphragmatic crura. […] The higher origin of celiac artery or lower insertion of diaphragmatic crura are likely to lead to MALS. […] Sometimes median arcuate ligament crosses the lower abdominal aorta causing compression. […] Compression can be due to thick, fibrous tissue or thin bands at or near the origin of celiac artery. […] The treatment of MALS aims at decompression of celiac artery to establish adequate blood flow and pain management by neurolysis. […] The neuropathic pain of MALS can be addressed with removal or ablation of ganglion and celiac artery revascularization. […] The role of intervention radiology is emerging in the treatment of MALS, though its outcomes are not promising. […] This may be due to the extrinsic compression of celiac artery causing intimal hyperplasia resulting luminal narrowing of artery. […] However, further definitive studies are needed to address the pathophysiology, better diagnose and devise minimally invasive treatment for this entity.
#189 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. […] The etiology and pathophysiology of MALS remain poorly understood but are believed to involve both ischemic and neuropathic components. […] Median arcuate ligament syndrome is a rare cause of chronic abdominal pain that poses a diagnostic challenge, particularly in pediatric patients. […] Vascular etiologies such as MALS should be considered when previous workup and management have failed to provide a definitive diagnosis.