Median Arcuate Ligament Syndrome (MALS)

Median arcuate ligament syndrome (MALS) is a condition in which the median arcuate ligament presses too tightly on the celiac artery (a major branch of the aorta that delivers blood to the stomach, liver, and other organs) and the nerves in the area (celiac plexus).

Ligaments are bands of tissue that connect one bone or cartilage to another. The median arcuate ligament is shaped like an arch and goes around the aorta (the artery in the heart that carries blood throughout the body) to connect the diaphragm to the spine.

In a person with MALS, the median arcuate ligament essentially acts like a hammer and the celiac axis acts like an anvil, compressing the take off of major vessels and squeezing nerves in between. (The “take off” is the spot where the celiac axis divides into three branches — the hepatic, left gastric and splenic arteries.) By compressing the artery right before it branches, MAL cuts off blood supply to the stomach and liver. This is a reason why patients complain of pain after meals.

Median arcuate ligament syndrome (MALS) is different than median arcuate ligament compression. Median arcuate ligament compression occurs in about 10% to 25% of the population and doesn’t cause any symptoms. In a very small number of these individuals, MALS is present, and healthcare provider with it will have the symptoms listed below.

Who is likely to have median arcuate ligament syndrome (MALS)?

MALS occurs most often in thin, younger women. It is a very rare condition.