median arcuate ligament syndrome

Median Arcuate Ligament Syndrome (MALS) Overview

Median arcuate ligament syndrome (MALS) is a rare condition characterized by the compression of the celiac artery, a major branch of the aorta, due to the excessive pressure exerted by the median arcuate ligament. This compression can lead to various symptoms and complications.

Common Symptoms:

• Bloating
• Weight loss
• Nausea
• Vomiting
• Abdominal pain

These symptoms are often nonspecific and can be similar to those experienced in other conditions, making diagnosis challenging [8].

Demographics Affected:

MALS predominantly affects young individuals due to the excessive compression of the celiac artery [5][6]. However, it can also affect children and adults alike, causing chronic abdominal pain [3].

Clinical Signs:

Frequently reported symptoms include epigastric pain, nausea, vomiting, weight loss, and postprandial or exercise-induced abdominal pain. Clinical signs may also be present, but they are often nonspecific [9].

Complications:

If left untreated, MALS can lead to complications such as:

• Malnutrition
• Weight loss
• Abdominal distension

It is essential to diagnose and treat MALS promptly to prevent these complications.

References: [1] Upshaw W (2023) - Median arcuate ligament syndrome: a review of the literature. [5] You JS (2013) - Median arcuate ligament syndrome: a rare entity characterized by extrinsic compression of the celiac artery. [6] Median arcuate ligament syndrome (MALS): an uncommon condition that predominantly affects young individuals due to excessive compression of the celiac artery. [8] Challenges in diagnosis include the nonspecific symptoms seen in the triad commonly associated with MALS: epigastric pain, weight loss, and abdominal distension. [9] Goodall R (2020) - Median arcuate ligament syndrome: a review of the literature.

Understanding Median Arcuate Ligament Syndrome (MALS)

Median Arcuate Ligament Syndrome (MALS) is a condition characterized by symptoms that can be similar to other stomach issues, making it challenging to diagnose. The following are the common signs and symptoms associated with MALS:

• Pain in the upper middle stomach area: This pain may radiate to the back or flank and can worsen after eating, exercising, or changing body position [6][8].
• Stomach pain after meals, exercise, or positional changes: The pain may be severe and can make it difficult to perform daily activities [3][9].
• Fear of eating or experiencing nausea: Some individuals with MALS may experience nausea or vomiting due to the discomfort caused by the condition [4][5].
• Weight loss: In some cases, patients with MALS may experience weight loss due to a decrease in appetite or difficulty consuming food [4].
• Bloating and blood pressure issues: Other symptoms associated with MALS include bloating, blood pressure fluctuations, and pulse rate changes [5].

It's essential to note that the symptoms of MALS can be similar to those experienced by individuals with other conditions, such as appendicitis, stomach aches, or irritable bowel syndrome (IBS). A proper diagnosis from a healthcare professional is necessary to confirm the presence of MALS.

References: [1] - Symptoms may be due to a lack of blood flow through the celiac artery or compression on nerves in the area. [2] - It's believed that MALS is caused by the median arcuate ligament compressing, or pinching the celiac plexus nerves over the celiac artery. [3] - MALS has symptoms similar to appendicitis, stomach aches, IBS and other stomach issues. [4] - Other symptoms include nausea and weight loss. In some patients the symptoms can be devastating and can lead to erroneous diagnoses of an eating disorder. [5] - Symptoms · Bloating · Vomiting · Weight loss · Radiating right or left flank and or back pain · Blood Pressure and Pulse issues · Near Fainting with Position Changes. [6] - The main symptom you'll notice with MALS is pain in your upper belly. It may hurt more after you eat or work out. The pain might make it hard to perform daily activities. [7] - Symptoms. Clinical presentation. Clinical presentation of patients with MALS can vary from severe pain in the upper abdomen associated with meals and exercise. [8] - Symptoms · 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. [9] - Signs & Symptoms of Median Arcuate Ligament Syndrome (MALS)? · Stomach pain after eating, exercising or changing body position · Chronic pain in the upper middle stomach area.

Median arcuate ligament syndrome (MALS) can be challenging to diagnose due to its vague presenting symptoms and lack of specific diagnostic criteria. However, various diagnostic tests are used to aid in the diagnosis.

• Imaging modalities: Imaging techniques such as duplex ultrasound, angiography, and gastric exercise tonometry are often utilized to assist in diagnosing MALS [7][13]. These tests can help identify compression or narrowing of the celiac artery by the median arcuate ligament.
• Physical examination and medical history: A thorough physical exam and questioning about symptoms and health history are essential for diagnosis. There's no specific test to diagnose MALS, and your healthcare provider will carefully examine you and ask questions [2][9].
• Upper endoscopy: An upper endoscopy can help doctors find problems with the digestive tract, which may be related to MALS [15]. However, this is not a direct diagnostic test for MALS.
• Multidetector computed tomography findings: Multidetector CT scans can provide valuable information about the condition of the celiac artery and surrounding structures, aiding in diagnosis [11].
• Radiology imaging: A combination of clinical symptoms and radiology imaging is used to make a diagnosis. There is also a surgical procedure that can be performed for treatment [10].

It's essential to note that the diagnosis of MALS is often made based on exclusion, as there are no specific diagnostic criteria. A multidisciplinary approach involving healthcare providers from various specialties may be necessary to accurately diagnose and manage this condition.

References: [2] - Nov 22, 2022 [7] - by W Upshaw · 2023 · Cited by 4 [9] - November 22, 2022 [10] - Jan 16, 2019 [11] - Median arcuate ligament syndrome: multidetector computed tomography findings. [13] - by R Goodall · 2020 · Cited by 123 [15] - September 10, 2023

Median Arcuate Ligament Syndrome (MALS) can be challenging to treat, and while surgery is often considered the most effective option, there are some alternative treatments that may provide relief.

• Gabapentin: A case report published in 2022 suggests that gabapentin, a medication commonly used to treat nerve pain, may be effective in reducing symptoms of MALS. The study found that gabapentin was able to modify symptoms and improve quality of life for the patient (1).
• Celiac Plexus Block: This is an injection of medication that can help relieve abdominal pain by blocking the celiac plexus, a network of nerves that transmit pain signals from the abdomen to the brain. While not specifically designed to treat MALS, it may provide some relief from associated pain symptoms (4).

It's essential to note that these alternative treatments are not as well-studied or widely available as surgical options for MALS. Surgery remains the most reliable treatment option for this condition.

References: 1. Gabapentin as a Symptomatic Modifier in Median Arcuate Ligament Syndrome: A Case Report and Assessment of Treatment Modalities (2) 4. Celiac Plexus Block (4)

Median Arcuate Ligament Syndrome (MALS) can be challenging to diagnose due to its rarity and similarity in symptoms with other conditions. Here are some differential diagnoses that should be considered:

• Gastroparesis: This condition involves delayed emptying of the stomach, which can cause epigastric pain and discomfort similar to MALS [7][8].
• Eating disorders: Conditions such as anorexia nervosa or bulimia can lead to abdominal pain and discomfort that may be mistaken for MALS symptoms [9].
• Irritable Bowel Syndrome (IBS): IBS is a common condition characterized by recurring abdominal pain, bloating, and changes in bowel movements. Its symptoms can overlap with those of MALS [7][8].
• Celiac artery compression syndrome: This condition involves compression of the celiac artery, which can cause similar symptoms to MALS, including epigastric pain and discomfort [10].

It's essential for healthcare providers to consider these differential diagnoses when evaluating patients suspected of having MALS. A thorough medical history, physical examination, and diagnostic imaging (such as CT or angiography) are crucial in making an accurate diagnosis.

References:

[7] by R Goodall · 2020 · Cited by 123 — Diagnosis. Diagnosis of MALS typically depends on exclusion of alternative causes of abdominal pain. Indeed, before investigation for MALS, a formal ...

[8] by R Goodall · 2020 · Cited by 123 — Diagnosis. Diagnosis of MALS typically depends on exclusion of alternative causes of abdominal pain. Indeed, before investigation for MALS, a formal ...

[9] Most doctors don't know about it, so MALS is underdiagnosed. Differential diagnosis for epigastric pain include gastroparesis, eating disorders, IBS, or ...

[10] Aug 6, 2024 — Celiac artery compression syndrome, also known as median arcuate ligament syndrome, Dunbar syndrome, celiac axis syndrome or Harjola-Marable ...