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MALS Abdominal Pain Surgery

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BACKGROUND: Median Arcuate Ligament Syndrome, or MALS, is a medical condition that may result in significant abdominal pain, according to the University of Chicago. The pain is attributed to the compression of the celiac artery by the median arcuate ligament, which can compromise blood flow needed for digestion. It can cause abdominal pain shortly after eating meals and exercising, and it can also cause weight loss.

DIAGNOSIS: Getting a diagnosis of MALS can be a long journey for many patients. The condition typically presents itself in teenagers and young adults. Sometimes, they are misdiagnosed as having irritable bowel disease or Crohn's disease. Some young patients are even sent to psychologists, because doctors think they have some kind of eating disorder.

Ultrasonography and Computed Tomography angiography along with 3-D imaging are used to give patients a definitive MALS diagnosis at the University of Chicago. These screening tests allow doctors to determine whether or not patients suffer from the typical narrowing of the artery that supplies blood to the digestive tract. It often looks like a hook, or crinkled hose, cutting off blood supply needed for digestion.

TREATMENT: At the University of Chicago, Dr. Donald Liu performs a laparoscopic surgery to ease the pain. It's done through a few tiny incisions in the stomach. Dr. Liu cuts the ligament, so it no longer crushes the blood vessel, and it springs back to the correct shape and blood flow returns to normal. It typically restores the patient's ability to eat and exercise, and in the majority of cases, alleviates the pain.

MISDIAGNOSIS: Dr. Liu says the condition may not be rare, just rarely diagnosed. "Patients get other labels, and that's the hardest part about it. One is they're labeled as being crazy. This is all in your mind, and that's the hardest thing to deal with especially if there's something there. Or, they're being labeled as anorexic, or they have an eating disorder, that's a very common thing," Dr. Liu told Ivanhoe.

Dr. Liu believes MALS is a condition that doctors need to look for when a patient comes in and complains of abdominal pain, especially linked to eating. Dr. Liu says young adults and teenagers may be particularly susceptible to MALS when they go through growth spurts.

Donald Liu, M.D., Ph.D.
University of Chicago
Chicago, IL

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