medial arcuate ligament syndrome (MALS)

Median arcuate ligament syndrome (MALS)

• is a rare disorder caused primarily by compression of the coeliac trunk by the median arcuate ligament (MAL)
  • affects approximately 2 per 100,000 people (1)
  • a higher prevalence in females (4:1 ratio), and most commonly affects individuals between 30 and 50 years of age (2)
  • according to The European Society for Vascular Surgery guidelines, MALS is the most common cause of single vessel abdominal arterial stenosis (2)
    
• disorder typically results in patients presenting with bloating, weight loss, nausea, vomiting, and abdominal pain
  • physical examination may reveal epigastric tenderness or bruising that worsens with expiration (2)
  • an epigastric bruit is reported to be audible on auscultation in up to 35% of patients based on physical examination but is certainly not pathognomonic (2)
    
• diagnosis is one of exclusion, as the disorder has no specific diagnostic criteria
  • imaging modalities are often utilized to assist in making the diagnosis, such as ultrasound, computed tomography angiography (CTA), and magnetic resonance angiography (MRA)
  • imaging modalities typically reveal a stenosed celiac artery with post-stenotic dilation in patients
    
• treatment
  • usually treated by dividing the MAL, thus relieving the compression of the coeliac artery
  • surgery may be done through either an open approach or a minimally invasive approach

Reference:

1. Upshaw W, Richey J, Ravi G, Chen A, Spillers NJ, Ahmadzadeh S, Varrassi G, Shekoohi S, Kaye AD. Overview of Median Arcuate Ligament Syndrome: A Narrative Review. Cureus. 2023 Oct 8;15(10):e46675.
2. Kiudelis M, Pažusis M, Kiudelis V, Kupčinskas J, Žvinienė K. Median arcuate ligament syndrome (MALS): A case report of a young patient. Int J Surg Case Rep. 2025 Apr;129:111178.