Median arcuate ligament syndrome

What causes median arcuate ligament syndrome?

The cause of median arcuate ligament syndrome (MALS) is disputed. While it was initially thought to be caused by a restriction of blood supply secondary to compression of the celiac artery (supplies blood to the upper abdominal organs) by the median arcuate ligament (a muscular fibrous band of the diaphragm), other factors have been proposed. It has been suggested that nerve dysfunction might additionally be involved, which could explain some of the associated symptoms such as pain and delayed gastric emptying.

Last updated on 05-01-20

How is median arcuate ligament syndrome diagnosed?

A diagnosis of median arcuate ligament syndrome (MALS) might be suspected in middle aged (40-60) female patients with a triad of symptoms including abdominal pain after eating, weight loss, and abdominal bruit (abnormal sound of a blood vessel when blocked or narrowed). Abdominal imaging is used to confirm the diagnosis and rule out other similarly presenting disorders. Imaging methodologies might include: CT angiography, MRI, ultrasound, and arteriography.

Last updated on 05-01-20

What is the long-term outlook for median arcuate ligament syndrome?

The prognosis for median arcuate ligament syndrome (MALS) varies. While long- term relief of symptoms has been described, many individuals unfortunately do not experience clinical benefits from surgery. In a large study of 51 individuals treated for MALS, the following factors were found to be associated with a favorable outcome after surgery :

  • Pain after eating (81% cured)
  • Age between 40 and 60 (77% cured)
  • Weight loss of 20 pounds or more (67% cured)

Less success was associated with the following factors:

  • Atypical pain patterns with periods of remission (43% cured)
  • Age greater than 60 (40% cured)
  • A history of psychiatric disorder or alcohol abuse (40% cured)
  • Weight loss less than 20 pounds (53% cured)

Last updated on 05-01-20

How might median arcuate ligament syndrome be treated?

Surgery is currently the only treatment option for median arcuate ligament syndrome (MALS). Surgery typically involves decompression of the celiac artery by dividing the fibers of the median arcuate ligament and celiac plexus (network of nerves in the abdomen). Surgical decompression might additionally be combined with stent placement, angioplasty, or vascular reconstruction of the celiac artery.

Last updated on 05-01-20

Name: National MALS Foundation P.O. Box 1292
Dedham, MA, 02027, United States
Email: Url:

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