Median arcuate ligament syndrome (MALS)


Median arcuate ligament syndrome (MALS) develops when the artery that supplies blood to the upper abdomen is compressed by the arc-shaped band of tissue in the chest region. The celiac artery is the name of the vessel. Some persons who have MALS have stomach ache.

Each person has a somewhat different position for the celiac artery and median arcuate ligament. Typically, the ligament crosses the body’s largest blood vessel (aorta) over the celiac artery, where it is located. But occasionally, the ligament or artery may be misaligned, leading to MALS. Moreover, the ligament may exert pressure on the celiac artery’s surrounding nerve system (celiac plexus).

MALS can strike anyone, including children. The MALS is also known as celiac axis syndrome, Dunbar syndrome, or celiac artery compression.

Surgery is used as a form of treatment to relax (decompress) the ligament and reopen the artery.


Compression of the celiac artery frequently goes unnoticed.

But, stomach pain that lasts for a long time (chronic) is a potential symptom of median arcuate ligament syndrome (MALS). The celiac artery may be blocked or nearby nerves may be compressed, which would cause the symptoms.

MALS may manifest the following symptoms:

  • Upper middle stomach pain that may subside as you lean forward
  • Abdominal discomfort with eating, exercising, or shifting body positions
  • Bloating
  • Diarrhea
  • Nausea and vomiting
  • Significant weight loss, typically more than 20 pounds, as a result of fear of eating because of pain

Stomach pain can have many distinct reasons. Call your healthcare professional if your stomach pain does not go away after receiving home care. A thorough physical examination and testing are required to identify the root reason.

Call your provider right away if your stomach discomfort is severe and getting up or moving makes it worse. If your stomach ache is accompanied by any of the following:

  • Yellowish discoloration of the eyes and skin (jaundice)
  • Extreme sensitivity to touch in the area around your belly
  • Chronic nausea and vomiting episodes
  • Abdominal swelling
  • Bloody stool
  • Fever

Upper stomach pain can occasionally be mistaken for chest pain. Heart attacks can sometimes be the cause. If you have chest or upper stomach discomfort with or without any of the following symptoms, get emergency assistance.

  • Chest pressure, fullness, or tightness
  • A piercing or crushing pain that radiates to your jaw, neck, shoulders, and one or both of your arms
  • Aches and pains that persist longer than a few minutes or get worse as you move about
  • Difficulty of breathing
  • Vomiting
  • Nausea
  • Cold sweats
  • Weakness
  • Dizziness


The actual cause of median arcuate ligament syndrome is unknown to medical professionals. There is debate concerning the origins and diagnosis of MALS.

Risk factors

The risk factors for MALS are uncertain because it is unclear what causes the illness. MALS has been observed in children, including twins, suggesting that genetics may be involved.

After pancreatic surgery and a traumatic blunt abdominal injury, some patients experienced MALS.