Description

Median arcuate ligament syndrome, also called mals, which occurs when the band of tissue in the upper part of the abdomen area of presses in the artery that sends blood to the stomach, the spleen and the liver. This tissue is called the median arcuate ligament. The artery is called the celiac artery.

The median arcuate ligament creates a pathway between the chest and the belly of the area for the main body of the blood vessels, called the aorta. Normally, the ligament passes through the aorta. The celiac artery is located just under the arch.

But sometimes, the ligament or arteries may be out of place. The ligament can 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 severe stomach pain in some people.

Mals can occur in anyone, even children. Other names for mals are:

  • Celiac artery compression syndrome.
  • Celiac syndrome.
  • Dunbar syndrome.

The treatment consists of surgery to release the pressure of the ligaments of the artery and nerves.

Symptoms

The pressure on the celiac artery does not always cause symptoms. Mals symptoms are mainly caused by pressure on the nerves.

The symptoms of mals include:

  • Stomach pain after eating or exercise.
  • The stomach pain gets better by leaning forward or backward, or standing up while eating.
  • Fear of eating foods because of the pain.
  • Unintentional weight loss.
  • The abdominal distension.
  • The diarrhea.
  • Nausea and vomiting.

When to see a doctor

There are many different causes of stomach pain. If your stomach pain continues despite home care, call your health care professional. You need a complete physical examination and testing to determine the specific cause.

If your stomach pain is bad, and the activity or the movement of the worse, call your healthcare provider immediately. Get medical help right away if your stomach pain occurs with:

  • Blood in the stool.
  • Fever.
  • The nausea and vomiting that does not go away.
  • Severe pain when you touch your belly.
  • Swelling of the belly.
  • Yellowing of the skin or whites of the eyes, also called jaundice.

Sometimes the stomach pain may be confused with pain in the chest. Sometimes chest pain may be due to a heart attack. Call 911 or emergency medical help if you have chest or upper stomach pain, with or without any of the following symptoms:

  • Pressure, fullness or tightness in the chest.
  • Crushing or searing pain that radiates to the jaw, neck, shoulders, and one or both arms.
  • Pain that lasts more than a few minutes or worsens with activity.
  • Shortness of breath.
  • Cold sweats.
  • Dizziness or weakness.
  • Nausea or vomiting.

Causes

The exact cause of median arcuate ligament syndrome, also called mals, is not known.

Risk factors

Because the cause of mals is poorly understood, the risk factors are not clear. Median arcuate ligament syndrome is more common in adults than in children. It is also more common among women than among men.

Mals has also been seen in identical twins, so genetics may play a role.

Some people have developed median arcuate ligament syndrome after pancreatic surgery or blunt trauma to the upper part of the stomach area.

Complications

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 be of great impact in the quality of life. Mals symptoms can be vague. The symptoms can be similar to other conditions. It may take some time to arrive at an accurate diagnosis.

Diagnosis

To diagnose the median arcuate ligament syndrome, also called mals, a healthcare professional will examine you and ask questions about your symptoms. The health care provider may hear a "whooping" sound, called a bruit, when you listen to your stomach with a stethoscope. The sound can occur when a blood vessel is narrow.

Tests

Because many conditions can cause stomach pain, usually you have many tests to find the cause and rule out other possible conditions.

The tests to diagnose the median arcuate ligament syndrome may include:

  • Blood tests. These tests are performed to verify that the health conditions that affect the liver, the pancreas, the kidneys, and other parts of the body. A complete blood count shows the level of white and red blood cells. A high white blood cell count can mean that there is an infection.
  • Ultrasound of the abdomen. This test uses sound waves to see how blood flows through the blood vessels. It can show if the celiac artery is compressed, especially when you inhale and exhale deeply.
  • The upper gastrointestinal endoscopy. This procedure is also called upper endoscopy, also known as an EGD. To see the esophagus, stomach and the upper part of the small intestine. During the PROCEDURE , a doctor guides a long, flexible tube with a camera on the end of the throat after application of the anesthetic. Also, samples of tissue, called biopsies, can be removed for laboratory testing.
  • Gastric emptying studies. The pressure on the celiac artery can reduce the speed of emptying of the stomach. These tests can show how quickly the stomach empties its contents. Slow or delayed emptying may be caused by other medical conditions.
  • Magnetic resonance imaging (MRI). An mri uses magnets and radio waves to produce detailed images of the body area being studied. Sometimes, dye, called contrast medium was administered INTRAVENOUSLY . The dye to show how blood moves through the arteries. This is called a magnetic resonance imaging, angiography, also known as MRA.
  • Abdominal computerized tomography (CT). A ct scan uses X-rays to create cross-sectional pictures of the body parts. This test can show whether the celiac artery is narrowed or blocked. A dye, called contrast, may be administered by the IV route . The dye helps the blood vessels to appear more clearly in the test images. When the dye is used, the test is called a computed tomography (ct angiography.
  • Celiac plexus block. Anesthetic is injected into the nerves that are located on each side of the celiac artery. The anesthesia lasts several hours. This treatment mimics what happens during surgery for the treatment of mals . This test is often used to learn how you can do well with mals surgery.

Treatment

Surgery is the only treatment for median arcuate ligament syndrome, also called mals. The surgery mals can improve or reduce symptoms in most people.

The most common is the surgical treatment of median arcuate ligament release, also called decompression. It is usually performed as an open surgery through an incision in the belly area. Sometimes it makes use of a camera and small instruments that passes through a number of smaller openings. This is called laparoscopic surgery.

During the decompression surgery, the surgeon will cut the parts of the median arcuate ligament. This reduces the pressure on the celiac artery and the nerves. The surgeon removes the nerves around the celiac artery and its branches. Bundles of nerves on each side of the celiac artery can also be eliminated.

Some people with mals may also need surgery to repair or replace a lock on the celiac artery and restore blood flow.

If you have mals release surgery, which typically remain in the hospital for 2 to 3 days. You can have an ultrasound or a ct scan about a month after the surgery to ensure that the blood flow is fully restored. You may need to see a nutritionist to help with the return to a healthy diet. This is particularly useful if you haven't been eating, or who have lost a lot of weight.

Lifestyle and home remedies

The pain and stress often occur in a cycle. The pain can make you feel stressed. Stress can make pain worse. Mals pain can make it difficult to eat, exercise, sleep and do everyday tasks.

Relaxation techniques, like deep breathing and meditation can reduce pain and improve mental health.

Coping and support

Live with mals can make you feel sad, anxious, or depressed. The challenge of reaching an accurate diagnosis can be overwhelming. Share your thoughts and feelings with others who have similar experiences can be helpful. A support group can provide emotional support and help to learn new coping skills.

The National mals Foundation provides information and connections for people with median arcuate ligament syndrome. Also, ask a member of your health care team to recommend a support group in your area.

Preparing for your appointment

Make an appointment with your health care professional if you have stomach pain that does not go away or other symptoms of median arcuate ligament syndrome.

An appointment can be brief and there's often a lot to discuss. So it's a good idea to be properly prepared for your appointment. Write your list of questions or concerns, it is one of the many steps you can take to prepare for your appointment.

What you can do

  • Be aware of any thing that you need to do before your appointment. You may be asked not to eat or drink anything for a couple of hours before some blood tests or imaging tests.
  • Write down all your symptoms, including those that do not seem to be related to the median arcuate ligament syndrome.
  • Write important personal information, including any family history of heart disease, stroke, high blood pressure, or blood clots, and any major stresses or recent life changes.
  • Make a list of all medications, vitamins or supplements you are taking. Include the dose and the reasons for each one.
  • A family member or a friend with you, if possible. Sometimes it can be difficult to understand and remember all the information that you receive during an appointment. The person who will be with you you can remember something that you missed or forgot.
  • Write down questions to ask your health care professional.

A list of questions from most to least important in case time runs out. For the median arcuate ligament syndrome, some basic questions to ask your health care professional include:

  • What is likely causing my symptoms or condition?
  • What are other possible causes for my symptoms or condition?
  • What kind of proof do you need?
  • What is the best treatment?
  • What is the proper level of physical activity?
  • What are the alternatives to the primary approach you're suggesting?
  • I have other health conditions. How can I best manage them together?
  • Are there any restrictions that I need to follow?
  • Is there any information that I can take my house? What sites do you recommend to visit?

Do not hesitate to ask any other questions.

What to expect from your doctor

Your healthcare provider is likely to ask many questions. Be prepared to answer them you can save your time to go through any concerns that you want to spend more time. Your health care team may ask:

  • When did the symptoms begin?
  • Do you always have symptoms, or the symptoms come and go?
  • How bad is the pain?
  • What, if anything, seems to improve your symptoms?
  • What, in any case, it makes your symptoms worse?
  • Avoid eating or exercising due to stomach pain?
  • Have you lost weight?
Symptoms and treatment of median arcuate ligament syndrome (mals)