Is MALS Curable? Median Arcuate Ligament Syndrome

The median arcuate ligament is shaped like an arch and goes around the aorta (main blood vessel in the body that carries blood from the heart to other organs) to connect the diaphragm to the spine. 

In a person with median arcuate ligament syndrome or MALS, the median arcuate ligament essentially acts like a hammer and the celiac axis acts like an anvil. It compresses the major blood vessels and squeezes the nerves between them.

When the median arcuate ligament compresses too tightly against the celiac artery (a major branch of the abdominal aorta) and compresses the nerves in the area called the celiac plexus (a network of nerves in the abdomen), it can cause pain and other symptoms.

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.

Compression of the celiac artery often doesn’t cause symptoms. However, some people with MALS may experience chronic stomach pain. 

Signs and symptoms of MALS may include:

• Pain in the upper middle stomach area (may go away when bending forward)
• Stomach pain after eating or exercising
• Fear of eating due to pain (which can lead to significant weight loss)
• Nausea 
• Vomiting
• Diarrhea
• Bloating

Once other conditions are ruled out, your doctor may order tests to look for MALS. Diagnostic tests may include:

• Mesenteric duplex ultrasound to check blood flow through the celiac artery and compression of the celiac plexus
• Computed tomography (CT) or magnetic resonance imaging (MRI) angiogram, which can give a better picture of the celiac artery and aorta
• Blood and urine tests to rule out other diseases and to diagnose the condition
• X-rays and upper endoscopy (a test that uses a lighted scope to look inside the digestive tract)

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 performed under general anesthesia, during which the surgeon divides the median arcuate ligament and celiac plexus. This gives the celiac artery more space, restores blood flow (revascularization), and relieves pressure on the nerves. Patients usually stay in the hospital for 2-3 days following the surgery. After a month, they undergo an ultrasound to confirm that blood flow is completely restored. 

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