PEDIATRIC SURGERY UPDATE: VOL 39 NO 03 SEPTEMBER 2012 has a concise review of Median Arcuate Ligament Syndrome (MALS) along with some references -listed with other references below (thanks to Ben Gold for this reference). MALS occurs when a fibrous portion of the diaphragmatic crura crosses the celiac artery and compression occurs. This disorder is described as a diagnosis of exclusion. Symptoms may include weight loss, nausea, abdominal pain, vomiting, and diarrhea. Imaging modalities including CT angiography, MR angiography or arteriography can increase the suspicion for this disorder.
While not alluded to in this reference, one of the problems is knowing whether MALS is a spurious finding. That is, in young individuals there is typically a robust blood supply to the intestine and it is not clear whether compression of the celiac trunk is responsible for specific symptoms as there is a compensatory blood supply.
Fortunately this disorder is very rare (or at the very least rarely recognized). One of the most experienced vascular surgeons relayed his experience over more than three decades. He stated that he had operated on four cases of suspected MALS –two improved with surgery. A better batting average than Chipper Jones! –but a lot fewer at bats.
- –Median arcuate ligament syndrome – Wikipedia, the free encyclopedia “It is estimated that in 10-24% of normal, asymptomatic individuals the median arcuate ligament crosses in front of (anterior to) the celiac artery, causing some degree of compression.”
- – Median Arcuate Ligament Syndrome – YouTube
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evaluation. J Vasc Interv Radiol. 22(4):556-61, 2011
- – Ozel A, Toksoy G, Ozdogan O, et al: Ultrasonographic diagnosis of
median arcuate ligament syndrome: a report of two cases. Medical
Ultrasonography 14(2): 154-157, 2012
- – Wani S, Wakde V, Patel R, et al: Laparoscopic release of median arcuate
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