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Median Arcuate Ligament Syndrome (MALS) Diagnosis & Treatment

Median Arcuate Ligament Syndrome, or MALS, is a rare but potentially debilitating condition affecting the celiac artery. Individuals with MALS may experience a range of distressing symptoms, including chronic abdominal pain, unexplained weight loss, and digestive problems. This article delves into the diagnosis and treatment of MALS, shedding light on how to manage this condition effectively.

Diagnosis of MALS

Diagnosing MALS is a complex process that necessitates a thorough evaluation. The following diagnostic techniques are typically employed:

  • Comprehensive medical history: The journey to diagnosis begins with a detailed medical history. Patients are encouraged to provide a comprehensive account of their symptoms, their duration, and any factors that exacerbate or alleviate their discomfort.
  • Physical examination: A physical examination may reveal tenderness in the abdominal area or, sometimes, the presence of an abdominal bruit, which is an abnormal sound that can indicate vascular abnormalities.
  • Imaging studies: Radiological tests are essential for confirming MALS. These include:
    • CT angiography (CTA): This non-invasive imaging technique provides highly detailed images of the blood vessels, aiding in the identification of any compression or narrowing of the celiac artery.
    • Doppler ultrasound: By assessing blood flow, this test can help determine whether there are obstructions or abnormalities in the celiac artery.
  • Selective angiography: In cases where other diagnostic tests are inconclusive, selective angiography may be performed to directly visualise the celiac artery and assess blood flow, ultimately confirming the presence of MALS.

Treatment options for MALS

Once a diagnosis is confirmed, several treatment options are available to manage MALS:

  • Lifestyle modifications: Patients are often advised to make specific dietary and lifestyle changes to alleviate their symptoms. Recommendations may include eating smaller, more frequent meals, and avoiding foods that trigger discomfort.
  • Medications: Some individuals with MALS may benefit from medication to control pain or manage associated conditions, such as irritable bowel syndrome.
  • Endovascular intervention: In certain cases, a minimally invasive procedure known as angioplasty with stent placement may be recommended. This procedure can alleviate the compression of the celiac artery, thereby reducing symptoms.
  • Surgical intervention: When other treatment approaches prove ineffective, surgical intervention may become necessary. During surgery, the ligament causing the compression is divided, providing relief to the celiac artery.
  • Multidisciplinary approach: Many patients find that a multidisciplinary approach is the most effective. This may involve collaboration between gastroenterologists, vascular surgeons, and pain management specialists, ensuring comprehensive care and support for individuals with MALS.

The early diagnosis and proper management of Median Arcuate Ligament Syndrome are crucial for improving the quality of life for affected individuals. By familiarising themselves with the diagnostic methods and various treatment options available, patients can take proactive steps toward managing their condition and finding relief from chronic abdominal pain.

At Birmingham HPB Clinic, we understand the complexities of MALS, and our experienced multidisciplinary team is dedicated to providing the highest level of care and support. If you or someone you know is dealing with MALS, don’t hesitate to get in touch with us. Our experts are here to guide you on your journey to recovery, offering personalised treatment solutions tailored to your unique needs. Contact Birmingham HPB Clinic today and take the first step towards a life free from the challenges of Median Arcuate Ligament Syndrome.