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Median arcuate ligament syndrome

  • Audra A. DuncanEmail author
Article

Opinion statement

Median arcuate ligament syndrome (MALS) can cause a range of symptoms, including abdominal pain, nausea, vomiting, and weight loss. Because all patients have some degree of celiac artery compression by the median arcuate ligament (MAL), it may be difficult to discern which patients have a pathologic compression. Based on the multiple theories of MALS etiology, it is unlikely that we know the true cause of this syndrome. In fact, there are many physicians who question the validity of the diagnosis of MALS. Before offering intervention for MALS, a thorough gastrointestinal evaluation should be performed, including consideration of diagnostic temporary percutaneous celiac ganglion block. Patients who are on chronic narcotics preoperatively have a lower likelihood of postoperative symptom relief and therefore should be evaluated by a pain specialist preoperatively. The most reliable treatment comprises open surgical treatment with division of the MAL, removal of surrounding celiac ganglion, evaluation of the celiac artery with pressure measurements or ultrasound, and celiac artery reconstruction if indicated. Laparoscopic and endovascular interventions are novel treatments and may be considered in select patients who cannot undergo an open surgical procedure.

Keywords

Mesenteric Ischemia Celiac Artery Chronic Mesenteric Ischemia Celiac Ganglion Median Arcuate Ligament 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.

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Copyright information

© Springer Science+Business Media, LLC 2008

Authors and Affiliations

  1. 1.Division of Vascular SurgeryMayo Clinic RochesterRochesterUSA

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