Median Arcuate Ligament Syndrome (MALS)

A description of the clinical manifestations, pathogenesis, diagnosis, and treatment of the median arcuate ligament syndrome.
MALS is also known as celiac artery compression syndrome, celiac axis syndrome, and Dunbar syndrome.
Illustrations of MALS courtesy of Dr. Matt Skalski, Radiopaedia.org, rID: 36837
CT images of MALS courtesy of Dr. Sami Elhinnawi, Radiopaedia.org, rID: 55455

[@62Sketch]

After 14 and half years of the same exact stomach pain and many many odd symptoms. Dozens and dozens of scans and test showing nothing wrong with me, a trip to the ER for chest pain the last 2 days and a CT Angiogram finally showed celiac artery compression. Hopefully surgery will return my quality of life back to normal. 14 YEARS of just not feeling right and pointing at my solar plexus to dozens of different DRs and they stumble upon the diagnosis looking for something totally different.

[@criticalthinker9829]

my wife had the same problem for last 3 years and she diagnosed her problem after going to so many doctors with no results.

[@user-nz1ih3wg5o]

Is it restored now? I hope you can reply to me, because I also detected recently, I don't know what to do.

[@grace683]

​@@user-nz1ih3wg5o I also might have it . But not confirmed 100% . I have to see a vascular specialist soon . It is very debilitating. I hope too get answers also . Good luck to you my friend .

[@zanadizeyi]

The most academic and professional clinician! Thanks a lot Dr. Eric.

[@leighsirvent654]

Thank you for bringing this to attention. It took me 16 years and a self diagnosis to finally get a mals diagnosis. Mine was neurogenic mals which means there was not a problem with blood flow. I had open surgery after a celiac plexus block and a definite low diaphragm and epigastric pain. I knew the minute I woke up that the knife, stabbing pain was gone, but because it took so long to diagnose, I have major nerve damage in that area.

[@humananatomybydrankit]

Very nicely explained , also do post about nut cracker syn if not done yet

[@user-nc2fw4ut7g]

Thanks for you

[@BrettPlaysWithGuns]

I have this currently with Nutcracker syndrome. Such a weird situation!

[@folumb]

Very satisfying surgery to watch

[@StrongMed]

Yes, I imagine so!

[@user-wz6oo9bq5j]

I read once that rapid weight loss is a risk factor (as the fat cushion below the celiac trunk would shrink) or is it another disease?

[@flower3787]

I believe this is SMA syndrome.

[@beatz3279]

This and nutcracker and TOs amd left so long i am now in so much nerve pain circulatory issued and severe pain in abdomen back chest and domino effect. Its got so bad i dont even have hope left due to the amoubt of nerve damage. I use ti be very strong but i am now willing to take my life as i cannot continue to disintegrate and live in this hell anymore. Legit at wits end

[@rajmishra2621]

Can Superior mesenteric artery syndrome be included in the differential?

[@mistylee717]

Does gastroperesis with a positive gastric emptying study make the diagnosis unlikely?

[@StrongMed]

I can't offer specific, individualized medical advice here, and there is a wide spectrum of "positive" for gastric emptying scans. Having said that, *in general*, I would say yes - if I saw a patient with chronic, post-prandial abdominal pain & nausea who had a definitively abnormal (i.e. not just borderline) gastric emptying scan, I'd say MALS would be very unlikely.

[@lurlinerigney3005]

Thanks for thus 💯👍

[@dailydoseofmedicinee]

👍👏

[@samikshyakharel1284]

Dr I have severe abdominal pain after meals and I can’t breathe feels like my food remain in chest .I have food regurgation when I take heavy meal .my all gi test gastroscopy . Ultrasound,gastric emptifying test , barium swallow come out normal is it might be mals or smas that causing me those symptoms . Even anxiety medicine are not working on me

[@RangerMcFriendly]

Get a CTA Scan done through your doctor.

[@twistedtea7046]

gonna pretend to shame every med student that doesnt put this in their differential. then give them a big JK lol. that way they will remember it!

[@user-gq3dl3cn2x]

😔😔😔😔