Median Arcuate Ligament Syndrome (MALS), also known as celiac artery compression syndrome, is a rare vascular condition that can cause severe abdominal pain. It occurs when the median arcuate ligament, a fibrous band of tissue in the diaphragm, compresses the celiac artery, the primary blood supply to the upper abdominal organs. This compression can lead to various symptoms and impact an individual’s daily life.

Overview

The median arcuate ligament is a normal anatomic structure that forms an arch across the front of the aorta, near where the celiac artery originates. In some individuals, this ligament is positioned lower than usual, causing compression of the celiac artery or celiac ganglia (a cluster of nerve cells near the artery). This compression can lead to reduced blood flow and abdominal pain, typically after eating.

Symptoms

The most common symptom of MALS is abdominal pain, which can range from mild to severe. It typically occurs after eating, as blood flow to the digestive organs increases. The pain is usually located in the upper abdomen, just below the ribcage, and may be accompanied by other symptoms, including:

• Nausea and vomiting
• Unintended weight loss
• Bloating or fullness after eating
• Diarrhea or constipation

Causes

MALS is primarily caused by the anatomical positioning of the median arcuate ligament, which varies among individuals. In some cases, the ligament is lower than usual, compressing the celiac artery or celiac ganglia. The exact reason for this abnormal positioning is unknown, but it is not considered a genetic or hereditary condition.

Risk Factors

The primary risk factor for MALS is having a low-positioned median arcuate ligament. However, other factors may increase the risk of developing symptoms:

• Age: MALS is more common in younger individuals, typically between 20 and 50 years old.
• Body type: People with a thin body type may be more prone to experiencing symptoms, as there is less fatty tissue to cushion the celiac artery from compression.

Preventing Complications

There is no known way to prevent MALS, as it results from an anatomical variation that is present from birth. However, individuals can take steps to manage their symptoms and improve their quality of life:

• Adopting a balanced diet: Eating smaller, more frequent meals can help reduce the severity of abdominal pain after eating.
• Maintaining a healthy weight: Gaining some weight, especially in underweight individuals, can help reduce symptoms by providing extra cushioning around the celiac artery.
• Seeking medical attention: Early diagnosis and treatment can help prevent complications and improve the overall quality of life.

When to See a Doctor

If you experience persistent abdominal pain, especially after eating, it’s essential to seek medical attention. Early diagnosis and treatment can help reduce discomfort and improve your quality of life. MALS can be challenging to diagnose, as its symptoms overlap with other conditions. A healthcare professional may order imaging studies, such as CT scans or MRIs, to visualize the blood vessels and assess for celiac artery compression.

Treatment Options

The treatment of MALS depends on the severity of symptoms and the degree of celiac artery compression. Options include:

• Dietary Changes: Eating smaller, more frequent meals can help alleviate symptoms.
• Pain Management: Medications like nonsteroidal anti-inflammatory drugs (NSAIDs) or antispasmodics may be prescribed to manage abdominal pain.
• Surgery: In severe cases, surgery may be recommended to release the median arcuate ligament and relieve compression of the celiac artery.

Median Arcuate Ligament Syndrome (MALS) is a rare vascular condition characterized by abdominal pain resulting from compression of the celiac artery. Although it can be challenging to diagnose and manage, with proper medical care, individuals with MALS can lead fulfilling lives. If you suspect you may have MALS, consult a healthcare professional for a comprehensive evaluation and personalized treatment plan.