Median Arcuate Ligament Syndrome (MALS)

Median Arcuate Ligament Syndrome (MALS) is a rare condition in which a band of tissue in the lower part of the chest (median arcuate ligament), rests lower than normal and presses against the celiac artery and the celiac plexus nerves. The celiac artery is a major blood vessel supplying blood to the stomach, liver, pancreas and other abdominal organs. When the celiac artery and plexus are compressed a number of symptoms may result as described below.

MALS is often misdiagnosed, as symptoms are similar to other conditions like Irritable Bowel Syndrome (IBS), appendicitis, gastritis, gallstones, peptic ulcer disease among others.  

Symptoms of MALS

• Upper abdominal pain typically after eating, may radiate to chest or back 
• Weight loss due to lack of appetite and stomach pain
• Nausea and vomiting
• Bloating 
• Diarrhea or constipation
• Heartburn
• Fatigue

MALS Causes and Risk Factors

The exact cause of MALS is not known. However, there are several factors that may increase a person’s risk of developing Median Arcuate Ligament Syndrome including:

• Anatomical variations – differences in body structure may cause the median arcuate ligament to sit lower than normal, pressing on the celiac artery and nerves.
• Age and gender –  anyone can have MALS, however, it’s  most common in thin, younger women between the ages of 20 and 40.  
• Family history – while genetic predisposition is unclear, there have been cases of identical twins with MALS leading doctors to believe there may be a hereditary component. 

How is MALS Diagnosed?

After accessing your symptoms and family history, followed by a physical exam, certain radiographic tests may help aid in the diagnosis including,

• MRA (Magnetic Imaging Angiography) – looks for signs of celiac artery compression
• CTA (Computed Tomography Angiogram) – detailed imaging that shows a cross-sectional view of the celiac artery to identify compression or narrowing
• Doppler Ultrasound – measures blood flow within the celiac artery
• Celiac Ganglion Block – temporary nerve block to determine if symptoms are related to celiac nerve compression

Dr. Anthony Vine has successfully treated many patients suffering from MALS. For more information, please visit our Laparoscopic MALS Surgery page.