Overview
The median arcuate ligament syndrome, MALS (also known as celiac artery compression syndrome) is a rare disorder characterized by postprandial stomach discomfort, accidental weight loss, and an epigastric bruit. The celiac artery is an aortic branch that supplies the stomach, liver, and other organs with blood. The median arcuate ligament syndrome occurs when the celiac artery becomes compressed between the median arcuate ligament, which wraps around the aorta to link the diaphragm to the spine, and the celiac plexus nerves encircling the aorta (MALS).
The median arcuate ligament is an arch of fibrous tissue that connects the diaphragmatic crura on each side of the aortic hiatus. Typically, the ligament crosses above the origin of the celiac axis. In certain individuals, however, the ligament inserts low and consequently crosses the proximal section of the celiac axis, producing compression and occasionally stomach discomfort.
Signs and symptoms
- Weight loss due to malabsorption
- Delayed gastric emptying
- Upper abdominal pain after eating meals
- Nausea and vomiting
- Bloating
- Constipation
- Dizziness
- Abdominal bruit
- Acid reflux
Diagnosis
- Blood tests to look for signs of malnutrition.
- Gastric emptying studies.
- Ultrasonogram of abdomen.
- Angiography – In this procedure, a catheter is placed into the artery, and dye is administered. On X-rays that depict movement, this enables the testing professional to determine if the artery becomes smaller during exhale and larger during inhalation.
- MRI angiography – A vein is injected with a contrast agent, and an MRI scan is performed to examine the celiac artery.
- CT angiography – Dye is injected through a vein, followed by a CT scan to provide pictures of the celiac artery.
Treatment
- Celiac plexus nerve block to relief pain
- Laparoscopic surgery (it is preferred surgical treatment due to less injury)
- Open surgery
Success rate
According to studies, between 60 and 80 percent of individuals who had celiac artery decompression received symptom improvement after surgery.
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