Median arcuate ligament syndrome (MALS)

Diagnosis

A particular test is not available to identify MALS. Your doctor will thoroughly examine you and inquire about your symptoms and medical background.

When using a stethoscope to listen to your upper stomach region, your doctor might hear a bruit. When a blood vessel is blocked or constricted, the sound is heard.

To help rule out more widespread causes of your symptoms, your doctor may also request specific testing, such as imaging and blood tests. They consist of gastritis, gastroparesis, Gastroesophageal Reflux Disease (GERD) or condition related to liver, pancreas, liver, spleen or intestine problems.

Your doctor can eliminate other causes of stomach discomfort with the aid of blood test and imaging studies.

The following tests may be performed to rule out other conditions and identify MALS:

• Blood exam. These examinations are performed to look for issues with the liver, pancreas, kidneys, and other organs. The quantity of white blood cells and red blood cells can be determined by a complete blood count. White blood cell counts over normal may indicate an infection.
• Abdominal ultrasound. High-frequency sound waves are used in this noninvasive procedure to examine blood flow through blood arteries. In particular, when breathing deeply in and out, it can indicate whether the celiac artery is constricted.
• Upper endoscopy. Also known as esophagogastroduodenoscopy (EGD), this technique. It is carried out to observe the stomach, esophagus, and upper small intestine (duodenum). After administering numbing medicine, the doctor performs an EGD by carefully guiding an extended, flexible tube with a camera on the end (endoscope) down the throat. During this operation, the clinician has the option to obtain tissue samples (biopsy).
• Gastric emptying studies. The rate at which the stomach empties can be slowed by celiac artery compression. To ascertain how quickly the stomach discharges its contents, gastric emptying tests are conducted. Several medical disorders may contribute to slow or delayed stomach emptying.
• Magnetic Resonance Imaging (MRI). An MRI creates finely detailed images of the body region being studied using strong magnets and radio waves. A blood artery may occasionally be injected with dye to help visualize how blood flows through arteries and veins (magnetic resonance angiogram).
• Computerized Tomography (CT) of the abdomen. In a CT scan, particular body components are imaged in cross-section using X-rays. If the celiac artery is obstructed or constricted, an abdominal CT scan might reveal this. To see blood flow in the arteries and veins more clearly, a healthcare professional will occasionally inject dye into a blood vessel (CT angiogram).

Treatment

The only available treatment for MALS is surgery. Medial arcuate ligament release, also known as median arcuate ligament decompression, is the most popular surgery. Often, it is performed as an open procedure. It can occasionally be performed using a minimally invasive technique (laparoscopic or robotic).

A surgeon divides the median arcuate ligament and the network of stomach-regional nerves (celiac plexus) while you are sedated. The artery has extra space as a result. It relieves pressure on the nerves and improves blood flow.

Some MALS patients may need open surgery to adequately repair or replace a blocked celiac artery and restore blood flow (revascularization).

Following the MALS release surgery, you will normally stay in the hospital for 2 to 3 days. You’ll need an ultrasound one month after surgery to confirm that blood flow through the celiac artery has been fully restored. Research have shown that surgery to release the median arcuate ligament is safe even in children with MALS. It frequently results in immediate pain alleviation and improves the quality of life for the person.