How is median arcuate ligament syndrome diagnosed?

If your doctor thinks you may have MALS, he or she will review your medical history and perform a physical examination. The doctor may also order certain tests, including blood work and imaging tests, to help rule out more common causes of your symptoms, such as gastroesophageal reflux disease (GERD), gastritis, gastroparesis, or problems with your pancreas, liver, gallbladder, spleen, or intestines.

Once these conditions are ruled out, your doctor may order a test called a mesenteric duplex ultrasound to check blood flow through the celiac artery and compression of the celiac plexus. Another helpful imaging test would be a CT or MRI angiogram, which can give a better picture of your celiac artery and aorta.

Once the diagnosis of MALS is suspected, our protocol at the Cleveland Clinic includes a three-step process:

  1. Your records will be reviewed and any additional imaging tests will be repeated or ordered (such as a mesenteric ultrasound of the celiac axis or a CT/MRI angiogram).
  2. You will be examined by one of our minimally invasive surgery specialists in the Section of Surgical Endoscopy of the Digestive Disease and Surgery Institute. A vascular surgeon in the Heart and Vascular Surgery Institute will also be available for consultation in more complex cases, if needed.
  3. You will also be evaluated by one of our pain management specialists for a potential celiac plexus block procedure. This offers temporary relief from the symptoms of MALS, and helps to confirm the diagnosis for the patient and the entire medical team.

What is a celiac plexus block?

A celiac plexus block is an injection of medication to help relieve pain in the abdomen.

Median arcuate ligament release

Median arcuate ligament release

If you have a celiac plexus block, you will be given an intravenous medication to relax you. Then you will lie on your stomach on an x-ray table. The doctor will numb an area of skin on your back with a local anesthetic. Then, guided by an x-ray, the doctor will:

  • Insert a thin needle into your back, next to your spine, and inject an anesthetic.
  • Insert a second needle on the other side of your spine.
  • Inject dye to make sure the medication goes to the correct spot.
  • Inject pain medication, such as epinephrine, clonidine, or a steroid. Alcohol or phenol also may be injected to destroy the nerves.

The procedure usually takes less than 30 minutes, and you can go home the same day. Your abdomen may feel warm, and you may begin to feel less abdominal pain.

Patients usually need a series of injections (between two and 10) to continue the pain relief. For some people, a celiac plexus block can relieve pain for weeks. For others, the relief can last years. Many can return to their normal activities.

Last reviewed by a Cleveland Clinic medical professional on 09/27/2017.

References

  • El-Hayek KM, Titus J, Bui A, Mastracci T, Kroh M. Laparoscopic median arcuate ligament release: are we improving symptoms? J Am Coll Surg 2013 Feb;216(2):272-9. doi: 10.1016/j.jamcollsurg.2012.10.004. Epub 2012 Nov 21.
  • Weber JM, Boules M, Fong K, Abraham B, Bena J, El-Hayek K, Kroh M, Park WM. Median Arcuate Ligament Syndrome Is Not a Vascular Disease. Ann Vasc Surg 2016 Jan;30:22-7. doi: 10.1016/j.avsg.2015.07.013. Epub 2015 Sep 10.
  • Genetic and Rare Diseases Information Center. Celiac artery compression syndrome Accessed 9/28/2017.
  • Jimenez JC, Harlander-Locke M, Dutson EP. Open and laparoscopic treatment of median arcuate ligament syndrome. J Vasc Surg. 2012 Sep;56(3):869-73.

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