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 pressure can cause the symptoms of MALS. The condition can cause serious stomach pain in some people. […] Symptoms of MALS include: Stomach pain after eating or exercising. The stomach pain gets better by leaning forward or backward or standing while eating. Fear of eating food because of pain. Unintended weight loss. Bloating. Diarrhea. Nausea and vomiting. […] A complication of median arcuate ligament syndrome, also called MALS, is long-term pain, especially after meals. The pain can lead to a fear of eating and significant weight loss. The pain and related depression or anxiety can greatly impact quality of life. MALS symptoms may be vague. The symptoms can be similar to those of other conditions. It may take some time to get an accurate diagnosis.

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

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

  Median arcuate ligament syndrome (MALS) is an uncommon condition that predominantly affects young individuals due to excessive compression of the celiac artery, the first large branch of the abdominal aorta located near the median arcuate ligament and celiac ganglion. The clinical presentation of patients with MALS can vary from severe pain in the upper abdomen associated with meals and exercise, to more subtle abdominal discomfort, nausea, and vomiting. Patients often require an extensive investigation with multiple consultations and diagnostic tests. MALS is often considered a diagnosis of exclusion, which is determined after other gastrointestinal disorders have been ruled out, and is strongly supported by the presence of severe epigastric pain with concomitant compression or narrowing of the celiac artery. Pain between the ribs and below the sternum, pain in either the side or back, and pain after eating and/or after exercise are common symptoms. Additional nonspecific symptoms of MALS include fatigue after eating, nausea/vomiting, weight loss, and constipation/diarrhea. […] Symptom improvement was noted in 80% of patients, with five-year freedom from recurrence symptoms in 70%. Among patients who answered a questionnaire on average seven years after the operation, 87% reported that they would still undergo operative management if given the choice.

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

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

  Median arcuate ligament syndrome (MALS) can cause intense pain in your upper abdomen that starts after you eat. […] Upper abdominal pain that happens after you eat is the first symptom of MALS. The pain may be so intense that you’re afraid to eat for fear that food will trigger symptoms. […] Surgery often eases symptoms. But research shows median arcuate ligament syndrome can come back after surgery. You can’t keep that from happening. But knowing what changes in your body may mean MALS is back may help.

• #3 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). This disorder typically results in patients presenting with bloating, weight loss, nausea, vomiting, and abdominal pain. […] The symptoms are typically more severe upon expiration due to the diaphragm moving caudally, resulting in greater celiac trunk compression by the MAL. […] Commonly reported symptoms of MALS include epigastric pain that is intensified after eating, severe abdominal pain, weight loss, diarrhea, and vomiting. […] 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. This low insertion of the MAL results in compression of the celiac artery, causing a decrease in blood flow to the foregut.

• #3 Overview of Median Arcuate Ligament Syndrome: A Narrative Review

  https://pmc.ncbi.nlm.nih.gov/articles/PMC10629207/

  Many patients with MALS are asymptomatic due to the extensive collateral circulation supplying the foregut. […] Data regarding the outcomes of patients who received treatment for MALS is lacking and has yielded somewhat conflicting results. […] One review found that in 35 studies involving a total of 691 patients, 75% to 100% of patients reported a clear reduction in symptoms after undergoing surgery. […] In another review of studies, 85% of MALS patients who underwent surgical intervention reported immediate symptom relief after surgery. […] 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. When patients present with MALS, they typically have symptoms such as vomiting or nausea, bloating, weight loss, and severe abdominal pain.

• #4 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. […] This compression leads to blood flow changes, as well as nerve entrapment and inflammation, causing a range of distressing MALS syndrome symptoms, including severe abdominal pain, particularly after eating, as well as unintended weight loss due to sitophobia (fear of eating), bloating, constipation, diarrhea, nausea, and vomiting. […] The hallmark of MALS is its excruciating pain, primarily concentrated in the upper abdomen, which often radiates to the back. The pain’s timing, typically occurring within 15-30 minutes after meals, is a distinctive feature that sets it apart from other gastrointestinal conditions. […] People with MALS are born with an anatomic abnormality of 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. […] Symptoms like abdominal pain after eating are usually relieved immediately after MALS surgery.

• #5 MALS | National MALS Foundation

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

  Median arcuate ligament syndrome MALS symptoms manifest as numerous gastrointestinal complaints and can range from intermittent mild to chronic debilitating that are triggered after eating or exercise. […] Common Symptoms associated after eating, exercise, positional movement: Epigastric Pain or Pressure, Postprandial Pain or Pressure, Chest Pain or Pressure, Vomiting, Diarrhea, Constipation, Dizziness. […] Unfortunately, MALS symptoms can all too often be dismissed by clinicians as non-specific, psychosomatic, or psychiatric, leaving many patients to suffer for months and years longer than they need to.

• #6 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 compression on the celiac artery can contribute to abdominal pain, commonly chronic and located in the epigastric region. […] This clinical vignette describes a patient with severe lactic acidosis in the context of unexplained chronic abdominal pain, nausea, vomiting, and syncopal symptoms and was found to have a clinical evaluation consistent with MALS. […] A 54-year-old female with a history of sleeve gastrectomy and provoked pulmonary embolism presented to an outside hospital with severe epigastric abdominal pain, nausea, and syncopal symptoms. […] The chronic waxing and waning achy upper abdominal pain was most severe post-prandially, with no other well-defined aggravating or alleviating factors from history gathered on positional changes, medications, or nutritional status. Associated symptoms included nausea, vomiting, syncopal symptoms, and intermittent loose, non-watery, non-bloody diarrhea.

• #6 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

  This case outlines a complex patient presenting with chronic abdominal pain who required urgent medical care in treatment evaluation of her severe lactic acidosis, which may have been induced by chronic ischemia secondary to MALS. […] Recognition of MALS as a potential etiology in the diagnostic evaluation of abdominal pain is of growing clinical importance. […] 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. […] Custati et. al found the most predominant symptoms of nausea and vomiting (56% of patients), with other symptoms less prevalent. […] Doppler vascular ultrasound to evaluate respiratory variation can help determine if compression is clinically significant and may be contributing to abdominal pain.

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

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

  Median arcuate ligament syndrome (MALS) occurs when the arc-shaped band of tissue in the chest area (median arcuate ligament) presses on, or traps, the artery that supplies blood to the organs in your upper abdomen (celiac artery). […] However, those with MALS can have long-term (chronic) stomach pain. Signs and symptoms of MALS include: Pain in the upper middle stomach area, which may go away when leaning forward; Stomach pain after eating, exercising or shifting body position; Fear of eating food due to pain, leading to significant weight loss — usually greater than 20 pounds (9.1 kilograms); Bloating; Nausea and vomiting; Diarrhea. […] MALS complications include long-term pain, especially after meals, which can lead to a fear of eating and significant weight loss. The pain and related depression or anxiety can greatly impact your quality of life. […] Surgery is the only treatment option for MALS. The most common procedure is called median arcuate ligament release, or median arcuate ligament decompression. It’s usually done as an open surgery but sometimes can be done as a minimally invasive (laparoscopic or robotic) procedure.

• #8 Clinico-pathologic findings in patients with median arcuate ligament syndrome (celiac artery compression syndrome) – PubMed

  https://pubmed.ncbi.nlm.nih.gov/33798927/

  Median Arcuate Ligament Syndrome (MALS) is a rare entity characterized by severe post-prandial epigastric pain, nausea, vomiting, and/or weight loss. […] They presented with chronic often post-prandial abdominal pain (4/4), nausea (3/4), emesis (2/4), anorexia (1/4), and weight loss (1/4). […] After surgical intervention, symptoms improved in three of the patients whose specimens show periganglionic and perineural fibrosis with proliferation of small nerve fibers. Our findings support neurogenic compression as a contributing factor in the development of pain and other MALS symptoms.

• #9 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. Patients with MALS commonly experience epigastric pain, chronic abdominal pain, nausea, vomiting, and unintentional weight loss. MALS symptoms vary but often include sharp upper abdominal pain, especially after eating or exercising. Nausea, vomiting, and unintentional weight loss are common, as patients may eat less to avoid discomfort. Other possible symptoms include bloating, diarrhea, and fatigue, making diagnosis challenging since these overlap with other conditions. Recognizing this spectrum of symptoms is crucial for early diagnosis and treatment. Since the severity and type of symptoms can vary widely, a comprehensive evaluation by a medical professional is essential to determine whether MALS is the underlying cause. Early intervention can help prevent further complications and provide relief from debilitating symptoms. […] Significant reduction in symptoms such as abdominal pain, nausea, and weight loss. Favorable long-term outcomes with lasting symptom relief for many patients.

• #10 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

  MALS reduces blood flow to the stomach, liver and other organs, which can result in pain in the upper part of the belly. The symptoms of MALS are often similar to appendicitis, stomachache, irritable bowel syndrome (IBS) and other stomach problems. […] Symptoms of MALS include: Stomach pain after eating, exercising or changing body position; Chronic pain in the upper middle stomach area, which may go away when leaning forward; Bloating; Nausea and vomiting; Diarrhea; Delayed gastric emptying (delay of food moving from the stomach into the small intestine); Fear of eating caused by pain, which can lead to significant weight loss (usually greater than 20 pounds). […] Most people who get this procedure report that their MALS symptoms, such as pain with eating and chronic pain in the upper middle stomach area, significantly improve after their surgery.

• #11 MALS: Median Arcuate Ligament Syndrome Overview

  https://www.verywellhealth.com/mals-median-arcuate-ligament-syndrome-4691027

  Median arcuate ligament syndrome (MALS) is a rare condition in which the median arcuate ligament located under the diaphragm in the abdomen compresses the celiac artery. This impairs blood flow to the stomach, liver, and other organs, causing chronic abdominal pain that can occur with eating or exercise. […] Symptoms of MALS may include the following: Severe chronic upper abdominal pain that usually gets worse after eating, Exercise-induced abdominal pain, Unintentional weight loss (50% of patients), Nausea, Vomiting, Diarrhea, Bloating, Abdominal bruit, a distinct noise heard with a stethoscope when listening to the stomach (35% of patients; indicates a vascular blockage). […] MALS usually results in severe and chronic abdominal pain. […] It is likely that a combination of these factors results in the characteristic symptoms of MALS.

• #11 MALS: Median Arcuate Ligament Syndrome Overview

  https://www.verywellhealth.com/mals-median-arcuate-ligament-syndrome-4691027

  MALS may affect both men and women of all ages but most often seems to affect young females between the ages of 30 to 50. It is approximately four times more likely to occur in women than in men. […] Once MALS is suspected, vascular imaging is necessary to confirm or rule out the diagnosis. […] Surgical decompression of the celiac artery is the only real treatment for MALS. However, not all people respond to this treatment. […] Studies show that approximately 60% to 80% of patients who underwent celiac artery decompression experienced relief of their symptoms following surgery. […] A small number of people do not experience symptom relief after a celiac artery decompression or even subsequent MALS surgical procedures. Better understanding of the pathology of MALS, including why a large number of people with significant celiac artery decompression never experience symptoms, is needed to improve the outcomes for all MALS patients.

• #12 Mackenzie Hild found relief for her median arcuate ligament syndrome (MALS) at UChicago Medicine – UChicago Medicine

  https://www.uchicagomedicine.org/forefront/heart-and-vascular-articles/mackenzie-hild-found-relief-for-her-median-arcuate-ligament-syndrome

  In her quest to become a doctor, a crucial step for Mackenzie Hild, 25, was to stop being a patient. […] But soon after she arrived in Uganda, her stomach began to hurt every time she ate. Physicians call this postprandial abdominal epigastric pain. […] But throughout the trip, she suffered profound postprandial pain. This time she lost 35 pounds — one-third of her normal weight. Worse yet, the pain didn’t ease up after she returned to the United States. Whenever she tried to eat, her stomach hurt for the next four hours. […] Unable to make the pain go away, her California doctors inserted a feeding tube into her stomach. That didn’t help. […] At last, the pain stopped. After that, all her nutrition came from fluids, dripping straight from a latex bag through a pump and into her intestine.

• #12 Mackenzie Hild found relief for her median arcuate ligament syndrome (MALS) at UChicago Medicine – UChicago Medicine

  https://www.uchicagomedicine.org/forefront/heart-and-vascular-articles/mackenzie-hild-found-relief-for-her-median-arcuate-ligament-syndrome

  Unfortunately, no matter what the cause, patients experience gut-wrenching pain that lasts for hours. Over time, it can do serious damage. […] As her multiple test results piled up and Hild’s various doctors ruled out the usual suspects, they began to consider MALS. […] The classic sign of MALS is a small kink in the celiac artery — visible on a three-dimensional CT angiogram, and confirmed by ultrasound imaging of blood flow through the artery — but it’s not always apparent. […] He warned her, however, „your pain may not go away.” […] „About 70 to 80 percent of our patients have an excellent outcome,” Skelly said, „but we can’t always tell in advance who the lucky ones will be.” For Hild, however, he felt the odds were better, „more like 85 percent.” […] The operation is technically simple, but complicated by the endless variety of individual anatomies.

• #13 What is Median Arcuate Ligament Syndrome (MALS)? — Accountability Muse

  https://www.accountabilitymuse.com/blog/what-is-median-arcuate-ligament-syndrome-mals

  Median Arcuate Ligament Syndrome is where, „the Median Arcuate Ligament encroaches on the celiac artery and the celiac ganglia.” […] The symptoms are awful. So first off, you get persistent abdominal symptoms, which can include pain after eating, epigastric pain or tenderness, early satiety, indigestion, nausea, vomiting, constipation and or diarrhea. […] You can also have autonomic symptoms from MALS because of how it affects the celiac plexus. So you can have pulse changes, AKA, your heartbeat, you can have blood pressure issues. […] It’s said that this epigastric bruit is heard in about 50% of MALS patients. […] Another thing is exercise intolerance. […] Median Arcuate Ligament Syndrome (MALS) is a rare entity characterized by severe post-prandial epigastric pain, nausea, vomiting, and/or weight loss.

• #13 What is Median Arcuate Ligament Syndrome (MALS)? — Accountability Muse

  https://www.accountabilitymuse.com/blog/what-is-median-arcuate-ligament-syndrome-mals

  Symptoms have been attributed to vascular compression (celiac artery compression syndrome, CACS), but it remains controversial whether they could be secondary to neural compression. […] After surgical intervention, symptoms improved in three of the patients whose specimens show periganglionic and perineural fibrosis with proliferation of small nerve fibers. […] Our findings support neurogenic compression as a contributing factor in the development of pain and other MALS symptoms.

• #14 Adult MALS | National MALS Foundation

  https://www.malsfoundation.org/adult-mals

  MALS symptoms manifest as numerous gastrointestinal complaints and can range from intermittent mild to chronic debilitating that are triggered after eating or exercise. […] Unfortunately, MALS symptoms can all too often be dismissed by clinicians as non-specific, psychosomatic, or psychiatric, leaving many patients to suffer for months and years longer than they need to. […] Common symptoms experienced after eating, exercise, positional movement include: Epigastric Pain or Pressure, Postprandial Pain or Pressure, Chest Pain or Pressure, Nausea, Vomiting, Diarrhea, Constipation, Bloating, Weight loss, Radiating Flank, Back Pain, Blood Pressure Issues, Dizziness, Orthostasis. […] These symptoms are a result of the disease process associated with MALS. They are associated with issues occurring in the diaphragm.

• #15 Symptoms

  https://med.uth.edu/cvs/patient-care/conditionsandprocedures/median-arcuate-ligament-syndrome-mals/mals-symptoms/

  Clinical presentation of patients with MALS can vary from severe pain in the upper abdomen associated with meals and exercise, to more subtle abdominal discomfort, nausea, and vomiting. […] Patients often require an extensive investigation with multiple consultations and diagnostic tests. […] MALS is often considered a diagnosis of exclusion, which is determined after other gastrointestinal disorders have been ruled out, and is strongly supported by the presence of severe epigastric pain with concomitant compression or narrowing of the celiac artery. […] Pain between the ribs and below the sternum. […] Pain in either the side or back. […] Pain after eating and/or after exercise. […] Additional nonspecific symptoms of MALS: Fatigue after eating. […] Nausea/vomiting. […] Weight loss. […] Constipation/diarrhea.

• #16 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. […] Patients experiencing MALS will typically have stomach pain soon after eating. Unfortunately, the only way to prevent pain is to limit or avoid eating, which can cause additional conditions. Patients may also have: Pain, Nausea, Weight loss, Exhaustion, particularly after a heavy meal, Inability to exercise. […] After suffering from debilitating stomach pain, Mackenzie Hild found relief for her median arcuate ligament syndrome (MALS) at the University of Chicago Medicine. Now, she is pain free for the first time in five years.

• #17 Median arcuate ligament syndrome often poses a diagnostic challenge: A literature review with a scope of our own experience

  https://www.wjgnet.com/1948-9366/full/v15/i6/1048.htm

  The median arcuate ligament syndrome (MALS) is recognized as a rare clinical entity, characterized by chronic post-prandial abdominal pain, nausea, vomiting, and unintentional weight loss. […] Due to its vague symptomatology, it is mainly regarded as a diagnosis of exclusion. Patients can often be misdiagnosed for several years before a correct diagnosis is established, also due to a medical teams clinical suspicion. […] It is characterized by recurrent episodes of post-prandial abdominal pain, nausea, vomiting, weight loss, and other more uncommon, but certainly potentially dangerous complications. […] Due to the confusing overlapping symptomatology between MALS and other chronic mesenteric ischemic clinical entities, many researchers believe that the syndrome may be under-diagnosed, as is the case in many patients with chronic mesenteric ischemia due to diagnostic delay.

• #17 Median arcuate ligament syndrome often poses a diagnostic challenge: A literature review with a scope of our own experience

  https://www.wjgnet.com/1948-9366/full/v15/i6/1048.htm

  The patient typically presents with postprandial abdominal pain, weight loss, nausea, vomiting, and diarrhea, among other complaints. […] Even though the syndrome presents a low prevalence in the population, the anatomical variations responsible for the syndrome are present at a rather large portion of the population. […] The patients from the cases presented fit the characteristics of MALS, but the syndrome remains mostly a diagnosis of exclusion. […] A very recent report from an expert panel on interventional radiology, regarding the topic of mesenteric ischemia, included MALS in their attempt to provide concise and evidence-based instructions for the diagnosis and treatment of mesenteric ischemia. […] Even though MALS is considered a diagnosis of exclusion, it should be considered in patients who seem to suffer from chronic mesenteric ischemic symptoms, but without a definite diagnosis.

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

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

  Median arcuate ligament syndrome (MALS), otherwise called celiac artery compression syndrome (CACS), is an uncommon disorder that results from an anatomical compression of the celiac axis and/or celiac ganglion by the MAL. Patients typically present with abdominal pain of unknown etiology exacerbated by eating along with nausea, vomiting, and weight loss. […] The typical symptom in MALS is chronic epigastric pain aggravated by meals. Other symptoms include nausea, vomiting, and accompanying weight loss. […] The initial presenting complaint in all four patients was chronic abdominal pain of unknown etiology despite an extensive evaluation from the previous providers. […] The median duration of symptoms before presentation was 3 (IQR 2, 4.8) years. […] The fear of provoking pain and delayed gastric emptying can result in weight loss.

• #19 MALS Awareness – Median Arcuate Ligament Syndrome | MALS Awareness

  https://malsawareness.com/mals

  MALS, which stands for Median Arcuate Ligament Syndrome, is a congenital anatomical anomaly. It can cause a change in blood flow and/or epigastric pain. […] Of those, half a million to 1.1 million will experience symptoms. […] MALS symptoms are most common among young women. […] The symptoms of MALS mimic gastrointestinal issues and may include upper-abdominal pain after eating, fatigue after eating, nausea and/or vomiting, constipation or diarrhea, exercise intolerance, and rapid weight loss. […] Patients are often misdiagnosed with gallbladder issues, chronic abdominal pain, gastroparesis, eating disorders/food avoidance, and a myriad of other non-specific diagnoses. […] MALS can only be treated with surgical intervention.

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

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

  The Median Arcuate Ligament Syndrome (MALS) is a rare clinical entity occurring due to abnormally low insertion of the ligament across the origin of the coeliac axis resulting in varying degrees of celiac artery compression. Its symptoms mimic those of chronic mesenteric ischemia and its diagnosis requires a high index of clinical suspicion coupled with appropriate imaging. […] A small number of patients with MALS show symptoms, which are similar to those of chronic mesenteric ischemia. […] The suffered group is usually young lean females between the age of 30 and 50 years and present with abdominal pain. Pain is located in the epigastric area and worsens after food intake, exercise, or on leaning forward. The pain is also associated with nausea, vomiting, bloating sensation, and passage of loose stools. Some patients may experience food fear and hence suffer from significant weight loss as seen in our case.

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

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

  MALS resembles several other abdominal disorders in its symptoms, posing a diagnostic challenge for the clinician. […] MALS is considered a diagnosis of exclusion, and it can coexist with other intra-abdominal pathologies and be a confounding factor. […] Surgery should be reserved for patients who would benefit from it, and patient selection continues to be challenging, as there is relatively poor correlation between the radiographic findings of celiac artery compression and the presence or severity of symptoms. […] Laparoscopic release of the arcuate ligament has become a widely accepted treatment.

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

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

  A 43-year-old woman was admitted with pain in the epigastrium and right upper quadrant that radiated to the back and was associated with nausea and dry heaves. […] The patients symptoms were not typical for MALS; they were new in onset and she had no weight loss, no abdominal pain after eating, and no food aversion. […] The most common clinical manifestation is chronic epigastric abdominal pain, most of the time postprandial or exercise-induced. Other symptoms include nausea, emesis, bloating, weight loss, and fear of the pain triggered by eating, leading to food avoidance. […] 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.

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

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

  Median arcuate ligament syndrome (MALS), also known as celiac artery compression syndrome, is an uncommon condition caused by the pressure of the celiac artery by low riding of fibrous connections of the middle arcuate tendon and diaphragmatic crura. MALS is frequently hard to diagnose because of the vague symptoms of weight loss, abdominal pain, and early satiety. […] Typical symptoms of MALS include abdominal pain: The most common symptom in the upper abdomen is pain that may worsen after eating or during physical activity, weight loss: Unexplained weight loss may occur due to a decreased blood supply to the digestive organs. Symptoms are typically most severe following rapid weight loss, nausea and vomiting: Food digestion issues might result in nausea and occasional vomiting, postprandial distress: Discomfort and bloating may result from symptoms that develop after meals, epigastric bruit: A whooshing sound called an epigastric bruit, may be heard over the abdomen with a stethoscope, malnutrition: Prolonged MALS can affect nutrient absorption, which may lead to malnutrition and vitamin deficiencies.

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

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

  MALS is a rare disease found in 2 out of 100,000 patients. The typical symptoms include stomach pain, nausea, and unexpected weight loss. […] Median Arcuate Ligament Syndrome (MALS) is a rare illness caused by the pressure of the celiac artery due to fibrous connections between the middle arcuate tendon and diaphragmatic crura. It has vague symptoms that make diagnosis challenging, such as early satiety, stomach pain, and sudden weight loss.

• #23 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 abdominal pain may be related to meals, may be accompanied by weight loss, and may be associated with an abdominal bruit heard by a clinician. […] Patients with MALS reportedly experience abdominal pain, particularly in the epigastrium, which may be associated with eating and which may result in anorexia and weight loss. […] Complications of MALS result from chronic compression of the celiac artery. They include gastroparesis and aneurysm of the superior and inferior pancreaticoduodenal arteries. […] The diagnosis of MALS relies on a combination of clinical features and findings on medical imaging. […] Classically, MALS involves a triad of abdominal pain after eating, weight loss, and an abdominal bruit, although the classic triad is found in only a minority of individuals that carry a MALS diagnosis.

• #23 Median arcuate ligament syndrome – Wikipedia

  https://en.wikipedia.org/wiki/Median_arcuate_ligament_syndrome

  The mainstay of treatment involves open or laparoscopic surgery approaches to divide, or separate, the median arcuate ligament to relieve the compression of the celiac artery. […] There are few studies of the long-term outcomes of patients treated for MALS. […] The syndrome most commonly affects individuals between 20 and 40 years old, and is more common in women, particularly thin women.

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

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

  Surgery is the only treatment for median arcuate ligament syndrome, also called MALS. Surgery for MALS can improve or reduce symptoms in most people. […] Pain and stress often occur in a cycle. Pain can make you feel stressed. Stress can make pain worse. MALS pain may make it difficult to eat, exercise, sleep and do everyday tasks. […] Living with MALS may make you feel sad, anxious or depressed. The challenge of getting an accurate diagnosis may be overwhelming. Sharing your thoughts and feelings with others who have similar experiences may be helpful. A support group can provide emotional support and help you learn new coping skills.

• #25 Median arcuate ligament syndrome (MALS) – Hancock Health

  https://www.hancockhealth.org/mayo-health-library/median-arcuate-ligament-syndrome-mals/

  Pain and stress often occur in a cycle. Pain can make you feel stressed. Stress can make pain worse. MALS pain may make it difficult to eat, exercise, sleep and do everyday tasks. […] Living with MALS may make you feel sad, anxious or depressed. The challenge of getting an accurate diagnosis may be overwhelming.

• #26 MALS Syndrome – Median Arcuate Ligament Syndrome (MALS)

  https://massivebio.com/mals-syndrome/

  MALS syndrome is a rare condition known as Median Arcuate Ligament Syndrome. It occurs when the median arcuate ligament, a fibrous band of the diaphragm, compresses the celiac artery, which supplies blood to the stomach, liver, and other organs. This compression can lead to a range of symptoms, including chronic abdominal pain, nausea, and weight loss. The pain often worsens after eating, leading some individuals to avoid meals and subsequently experience significant weight loss. […] MALS syndrome can significantly impact the quality of life due to its debilitating symptoms. […] The symptoms include: Chronic abdominal pain, Nausea, Vomiting, Weight loss, Pain that worsens after eating, Bloating, Diarrhea, Feeling full quickly after beginning to eat. […] Patients with MALS often experience significant pain after eating, as the reduced blood flow cannot meet the digestive systems increased demands.

• #26 MALS Syndrome – Median Arcuate Ligament Syndrome (MALS)

  https://massivebio.com/mals-syndrome/

  The success of this surgery can significantly improve a patients quality of life and reduce symptoms. […] Although MALS can be debilitating, it does not typically affect life expectancy if appropriately managed. Patients undergoing successful treatment, including surgery, often experience substantial relief from symptoms and can lead normal, healthy lives.

• #27 Median arcuate ligament syndrome (MALS) | Health Library | Memorial Health System

  https://www.mhsystem.org/health-library/con-20459603/

  Surgery is the only treatment for median arcuate ligament syndrome, also called MALS. Surgery for MALS can improve or reduce symptoms in most people. […] Pain and stress often occur in a cycle. Pain can make you feel stressed. Stress can make pain worse. MALS pain may make it difficult to eat, exercise, sleep and do everyday tasks.

• #28 Is MALS Curable? Median Arcuate Ligament Syndrome

  https://www.medicinenet.com/is_mals_curable/article.htm

  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. […] The surgery is safe, provides symptom relief, and improves quality of life.

• #29 Median arcuate ligament syndrome (MALS) | Altru Health System

  https://www.altru.org/health-library/conditions/median-arcuate-ligament-syndrome-mals

  Median arcuate ligament syndrome, also called MALS, happens when the band of tissue in the upper belly area presses on the artery that sends blood to the stomach, spleen and liver. […] The condition can cause serious stomach pain in some people. […] Symptoms of MALS include: Stomach pain after eating or exercising. […] The stomach pain gets better by leaning forward or backward or standing while eating. […] Fear of eating food because of pain. […] Unintended weight loss. […] Bloating. […] Diarrhea. […] Nausea and vomiting. […] A complication of median arcuate ligament syndrome, also called MALS, is long-term pain, especially after meals. The pain can lead to a fear of eating and significant weight loss. […] Surgery is the only treatment for median arcuate ligament syndrome, also called MALS. Surgery for MALS can improve or reduce symptoms in most people. […] During decompression surgery, the surgeon cuts away parts of the median arcuate ligament. This reduces pressure on the celiac artery and nerves.

• #30 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

  The pathophysiology of MALS is unclear but is likely an interplay between coeliac artery and coeliac ganglion compression. […] Coeliac plexus block, open surgical or laparoscopic MAL release and coeliac ganglionectomy have been found to be effective. However, the durability of symptom relief is variable.

• #30 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. […] The clinical presentation can include postprandial abdominal pain, nausea and vomiting, food fear, constipation or diarrhoea, and weight loss. […] MALS occurs most commonly in young women. They describe abdominal pain, weight loss, bloating, nausea and vomiting, which can be related to eating and drinking or be exercise induced. […] 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. […] Postprandial and post-exertional abdominal pain in young women without an alternative diagnosis should undergo investigation for MALS via Doppler ultrasound, computed tomography angiography and, if available, gastric.

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

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

  If you experience persistent abdominal pain, especially after eating, its essential to seek medical attention. Early diagnosis and treatment can help reduce discomfort and improve your quality of life. MALS can be challenging to diagnose, as its symptoms overlap with other conditions. A healthcare professional may order imaging studies, such as CT scans or MRIs, to visualize the blood vessels and assess for celiac artery compression. […] The treatment of MALS depends on the severity of symptoms and the degree of celiac artery compression. Options include: Dietary Changes: Eating smaller, more frequent meals can help alleviate symptoms. Pain Management: Medications like nonsteroidal anti-inflammatory drugs (NSAIDs) or antispasmodics may be prescribed to manage abdominal pain. Surgery: In severe cases, surgery may be recommended to release the median arcuate ligament and relieve compression of the celiac artery.

• #32

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

  MALS complications include long-term pain, especially after meals. The pain can lead to a fear of eating and significant weight loss. The pain and related depression or anxiety can greatly impact quality of life. MALS symptoms may be vague and can mimic other conditions. It may take some time to get an accurate diagnosis. […] Surgery is the only treatment option for MALS. The most common procedure is called median arcuate ligament release, or median arcuate ligament decompression. It’s usually done as an open surgery. Sometimes it can be done as a minimally invasive (laparoscopic or robotic) procedure. […] If you have MALS release surgery, you’ll usually stay in the hospital for 2 to 3 days. You’ll need an ultrasound about a month after surgery to confirm that blood flow through the celiac artery is fully restored. Several studies have shown that surgery to release the median arcuate ligament is safe, even in children with MALS. It often results in immediate pain relief and improves the person’s quality of life.

• #33 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. It mostly will affect young women who have stomach pain after eating or exercise. They might also have nausea, vomiting and weight loss. […] Most people with MALS have pain in their upper stomach. This may be worse after eating and sometimes after exercise. Nausea and weight loss are also common. Sometimes turbulence can be heard from the narrowing in the artery with a stethoscope. People with MALS are also more likely to suffer from anxiety. […] Once a diagnosis of MALS seems likely, the aim of treatment is to relieve the pressure on the coeliac artery. This can be treated by dividing the ligament and, as well, the nerves around the artery will most likely be taken out at the same time. […] Most patients (80%) get relief of their symptoms straight away after treatment and few will have these return.

• #34 Median Arcuate Ligament Syndrome – Practical Gastro

  https://practicalgastro.com/2015/02/05/median-arcuate-ligament-syndrome/

  Median arcuate ligament syndrome is an uncommon disorder first described in the 1960s. It is characterized by epigastric abdominal pain accentuated by meals and weight loss associated with nausea, vomiting and gastroparesis. […] Most patients report chronic epigastric and right upper quadrant abdominal pain which is accentuated after meals. Weight loss is explained by reluctance to eat for the fear of provoking pain. There are also symptoms that are manifestations of delayed gastric emptying, namely nausea and vomiting. […] Following surgical decompression, the outcomes have varied widely in the literature mainly because the patients differed in presentations and comorbidities. While symptoms have resolved in most patients after intervention, some others did not have appreciable clinical benefit. […] Surgical decompression relieves abdominal pain, nausea, vomiting, gastric dysrhythmia, and gastroparesis in most patients but a subset have some continuing pain component.

• #35 Median Arcuate Ligament Syndrome: Symptoms, Causes and treatment

  https://www.medicoverhospitals.in/diseases/median-arcuate-ligament-syndrome/

  The symptoms of MALS can vary widely among patients, making diagnosis challenging. However, several symptoms are commonly associated with the syndrome. […] The most prevalent symptom of MALS is chronic abdominal pain. This pain is often described as a dull ache or a burning sensation in the upper abdomen. It can be exacerbated by eating, leading some patients to experience significant weight loss due to a reluctance to eat. […] In addition to abdominal pain, patients with MALS may experience nausea and vomiting, diarrhea, unintentional weight loss, a feeling of fullness after eating only a small amount, and bloating. These symptoms can be intermittent, and their severity may fluctuate over time. […] Post-surgery, patients often experience significant relief from symptoms. However, the degree of symptom relief can vary, and some patients may continue to experience discomfort.

• #36 Median Arcuate Ligament Syndrome (MALS) | CHRISTUS Health

  https://www.christushealth.org/get-care/services-specialties/pediatric-care/general-surgery/median-arcuate-ligament-syndrome

  MALS can be treated effectively through minimally invasive surgery, which aims to relieve the pressure on the celiac artery. This procedure typically results in significant pain relief, often within the first 24 hours post-surgery, with continued improvement and full recovery usually occurring within two weeks.

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

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

  Median Arcuate Ligament Syndrome (MALS) is a rare condition in which the median arcuate ligament, a band of tissue in the diaphragm, compresses the celiac artery a major blood vessel that supplies oxygenated blood to the upper abdominal organs. This compression leads to restricted blood flow, causing pain, discomfort, and a variety of digestive symptoms. […] Before diving into treatment options, it’s essential to recognize some common symptoms of MALS: Severe upper abdominal pain after eating, Unintentional weight loss, Nausea and vomiting, Bloating, Fatigue and dizziness. […] Because MALS symptoms can mimic other gastrointestinal issues, diagnosing it often requires imaging tests such as Doppler ultrasound, CT angiography, or MRI to confirm the compression of the celiac artery. […] Most patients experience significant relief from their symptoms within a few weeks, although full recovery may take a few months. […] In the days following surgery, you’ll likely notice an improvement in abdominal pain and digestive issues.

• #38 Is Median Arcuate Ligament Syndrome (MALS) linked to EDS and POTS? | The EDS Clinic

  https://www.eds.clinic/articles/median-arcuate-ligament-syndrome-mals-linked-eds-pots

  MALS is increasingly recognized in patients with connective tissue disorders like Ehlers-Danlos Syndrome (EDS) and autonomic nervous system disorders like Postural Orthostatic Tachycardia Syndrome (POTS). […] In patients with EDS, the connective tissue abnormalities may predispose them to vascular compression syndromes like MALS. Studies have shown that EDS is more prevalent in patients with MALS than in the general population. […] There is evidence that MALS is more common in patients with POTS. The overlap in symptoms between MALS and POTS, such as dizziness and gastrointestinal discomfort, suggests a possible link between these conditions. […] Median Arcuate Ligament Syndrome (MALS) is a rare but significant condition that can cause chronic abdominal pain and other debilitating symptoms. Its links to conditions like EDS and POTS highlight the importance of considering MALS in patients with these disorders, particularly when they present with unexplained gastrointestinal symptoms.

• #39 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. It is also referred to as celiac artery compression syndrome, celiac axis syndrome, and Dunbar syndrome. It is an uncommon disorder that is characterized clinically by the triad of postprandial abdominal pain, weight loss, and sometimes an abdominal bruit. […] The diagnosis is often one of exclusion, given the nonspecific symptoms that overlap with other forms of chronic intestinal ischemia. […] Treatment involves surgical decompression of the celiac axis. Treatment success, which cannot be guaranteed, depends upon appropriate patient selection. […] 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.

• #40 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. […] The clinical components of pain varied positional or respirational change and continuous pain were significantly different among all the groups (P 0.01). […] We suggest renaming MALS as NCGAPS, nutcracker celiac ganglion abdominal pain syndrome, to better explain the mechanism of the recurrent abdominal pain. […] The pain can be varied by changes in position, independent of eating or defecation. […] The most common celiac trunk indentation sign was noticed in 1 patient (33.3%) in the highly clinically suspicious group and 13 patients (68.4%) in the weakly suspicious group, but it was statistically insignificant (P = 0.350).

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