Chapter 56 - Unrelenting stomach and midback pain, particularly when eating: Epigastric pain and nausea with eating in a person with median arcuate ligament syndrome (MALS)

Abstract

The diagnosis and treatment of median arcuate ligament syndrome (MALS) in this case study resulted from the recognition of compression of the celiac artery and its associated sympathetic celiac ganglion by the median arcuate ligament within the abdomen. Chronic neuropathic changes (nerve injury) of the nerve plexus result in severe epigastric pain (over the stomach)—and often midback pain. These pain symptoms are associated with eating and usually result in weight loss. A physical examination, ultrasound and CT imaging, and celiac ganglion nerve block will usually establish the diagnosis. Treatment involves surgical resection of the median arcuate ligament and the celiac plexus and usually achieves excellent results. The reader is also referred to the chapters discussing full stomach, gastroesophageal reflux disease (GERD), pelvic prolapse, and May-Thurner syndrome (in which abdominal pain is common).