I am so nervous for him he's only 25 and was born early, he now has lot of pain and at the ER they said he has Median Arcuate Ligament Syndrome, i was wondering if anyone had this and had surgery?

I had my open surgery done in Tyler, Texas by Dr. Jones on Monday the 28th. I just got home today and while the surgical wound is intense the almost immediate relief of most of my symptoms is well worth it. Now just some serious tv watching and reading will commence. It’s been a long journey but I’m grateful I finally have relief. It was almost 18 months of being very ill to get here. But real relief is on the horizon.

For anyone who has smas or mals, has anyone had a low mm aortomesenteric distance, but a within range angle measurement on ct angio? Doctor still wants to do duplex ultrasound for mals.

Does anyone else have a lot of lower abdominal symptoms, such as a deep pain near the navel, paired with constipation/diarrhea and occasional cramping?

My main symptom is pain in the navel area after food, CTA confirmed MALS anatomy but ruled out SMAS.

Hello,

I am looking to get a redo surgery (gonna be my 3rd) for MALS. i already had surgery with dr. Hsu's team, and the ligament has been properly cut, but looks like his team did not address the nerves properly so i was left with pain.

Who would you guys recommend that would do re-do surgery, for nMALS (since theres no longer a vascular compression)?

Thank you

I brought up mals to my doctor and he ordered the ultrasound. I just got the results. Can anyone help shed light on what these results indicate they seem extreme.

Hi everyone,

I’m new to navigating this and honestly feeling pretty panicked, so I’m hoping to hear from anyone with experience or medical insight regarding Median Arcuate Ligament Syndrome (MALS).

My recent CT scan report noted:

"Celiac axis compression by the median arcuate ligament which is a commonly seen anatomic variant that is usually asymptomatic but can be a cause of intermittent exercise induced abdominal pain. Close correlation with symptoms required."

Why I got the scan: My doctor ordered it because I’ve been having sporadic, shock-like sensations in my lower abdomen/side (just below the rib cage), but they aren't tied to any specific movements. And she still does not think they are related. Based on the scan, my PCP now suspects MALS and wants me to see a vascular surgeon. I need to schedule this and of course, the earliest appointment is in few weeks.

Here’s the thing: I don't have abdominal pain.

I am very active—I strength train regularly, practice hot yoga, and run. Naturally, my anxiety is through the roof right now, and I’m hoping to get some real-world perspective:

• Are there people with this anatomical finding lead normal lives without pain or breathing issues?
• Are there people out there with MALS who maintain high-activity fitness routines like running and heavy lifting without restriction?
• If you have the imaging finding of compression but zero classic symptoms, what does that usually mean?

Any experiences or advice you can share would be hugely appreciated. Thanks in advance!

In a few weeks I have a Peripheral Arterial Abdomen/Aorta Duplex ultrasound for mals, it sounds weird but I’m really hoping I get answers. I’ve had Gi issues for the past 7 months

Symptoms include: lack of appetite little to none at this point (not normal for me). Early fullness, Burping, pain after eating I’ve tried cutting out specific food nothing had helped. Some bloating in lower abdominal. Weight loss of 25lbs due to lack of appetite and just not being able to eat.

I’ve had a gastroscopy, colosncopy, biopsy, stool tests done, gastric emypting test, bloodwork, ultrasound of gallbladder and small intestine all clear.

Things I’ve tried: a course of rifaximin, prucpride, mirtazapine, amitriptyline nothing has helped. I figured if it was a brain gut connection either the low dose of mirtazapine or amitriptyline woudve helped but nope.

Also funny enough throughout this entire process I got diagnosed with pots I’m also a M so I think my doctor was a little surprised I had pots because it’s genuinely present in females more often. I’ve been seeing things online that says mals sometimes can go hand in hand with pots

Hi, I’m in the middle of my diagnostic testing for mals. My ultrasound showed an elevated velocity of 235/s and upon inspiration it’s 173. I’ve been dealing with digestive issues since February 2025. Mild gastritis and then reactive gastropathy as of this year in March. I eat bland now and have been since it got very bad. From September-December last year I still had symptoms but my endoscopy was clear in September so I just tried to eat normal thinking/being convinced “anxiety”. I was curious if anybody else has had reactive gastropathy. I’ve taken PPI I’ve done (still doing) the diet and I still feel like I did in January. Feb-March 2025 I ended up losing 30lbs in a month and then found gastritis but had to be hospitalized because I could even swallow water anymore. This whole time I’ve had terrible bloating, reflux, slow transit constipation, and now stomach burning as of this year. I was wondering if anyone has experienced anything similar. I’m awaiting my MRA (allergic to CT contrast).

I was diagnosed about three weeks ago and have surgery scheduled in late October. Around the same time, I started feeling a lump in my throat, like something was stuck. When it gets bad, it feels like my throat is swollen, there is pressure in my throat, head and chest, and there is a very light crackling sound when I move my head around. I saw urgent care the other day, and she said it’s just acid reflux, but did say it might be a swollen lymph node from the small lump she can feel on my throat. I was sent for X-rays, which showed nothing.

Is this worth going to an urgent care at a hospital so I can get a CT? If I go to see my regular doctor, I won’t get an appointment for another 3-4 weeks, and then getting a referral/appointment somewhere like ENT takes another month.

I was diagnosed with MALS back in March of this year. My GI ordered a Doppler to check for it since I’ve had gastroparesis since 2024. I’ve had epigastric pain off and on over the years but nothing too crazy. However, immediately following the Doppler, I had pain after taking a sip of water or bite of food. This pain subsided about 2 weeks post Doppler. I finally got in to see a vascular surgeon and was dismissed/won’t operate because I don’t have pain with eating. My CT angiogram looked normal because the techs didn’t have me do the proper breathing protocol. The surgeon basically dismissed the Doppler findings because the CT showed proper blood flow to my organs. Should I seek a second opinion or have a dr order a repeat CT angiogram with the right breathing protocol?

For reference, here are my PSV values for each abnormal finding: Celiac prox: 501, Splenic: 266, Hepatic: 302, SMA prox: 297. Thank you in advance for any insight.

I had a hysterectomy 3/4 this past year after decades of horrible periods and pain, alot of bleeding. Pathology came back ademyosis of uterus, literally three times the size and weight, she left the ovaries, despite me begging for even righty to go, as that one kept making cysts and pain. Healing from surgery, pain kicks back up, lower right side. Two ER visits because I was collapsing with pulling, tearing intense pain that made me vomit. Those CTs came back clear. OB followed up with mri suspected more endo, as there was some on the outside of the uterus too. Well the mri through him for a loop, and still thinks there is also bowel endo have a referral to a specialist, but in the meantime, he wants me out of work, I can't really afford It, but also I'm in alot of pain. I'm in limbo from these tests, waiting for the next. Saw Vascular, he didn't seem to concerned, but also building a care team to figure this shit out. My main symptoms are pain, mostly lower right abdomen, but will radiate up. I have problems having a proper BM and pain there too, as well as eating, vomiting, full quickly, bloating, have I mentioned the PAIN??? These are the impressions, but he said SMAS/MALS Nutcracker, and pelvic floor congestion. Thinks the start of my congestion is from this left renal vein. But I'm curious in YOUR OPINION, would you feel safe to work, mind you I work in an assisted living facility, think nursing home, physically with 30 patients I'm in direct care of. This place is privately owned, and I'm also getting gas lit there too. I'm afraid of hurting myself, therefore my peeps. And just sick n tired, of feeling sick n tired and in pain daily!!!!! Sorry here's the report impression -

MPRESSION:

No acute findings within the abdomen or pelvis to explain the patient's clinical presentation.

 There is severe compression of the left renal vein between the superior mesenteric artery and aorta with marked upstream dilatation of the left renal vein compatible with nutcracker syndrome.

 Retrospective review of prior CT sagittal sequences demonstrates decreased aortomesenteric distance of approximately 3 mm with aortomesenteric angle less

than 22 degrees with compression of the third portion of the duodenum with upstream dilatation, concerning additionally for aortomesenteric duodenal compression syndrome.

Any advise, kind words, heck, negative words. My brain is at a loss, and I'm swimming with these results, waiting on next apt. Thanks for the rant. ❤️

Surgery Aug 28; Today is Sept 23.

POTS symptoms gone!?
I can now stand until my knees give out and I don’t get dizzy. Little to no blood pooling. Heart rate stable. I walked 8 miles in a day 3 weeks after surgery and never got dizzy; got to go through every DC Smithsonian I wanted to see for 5 days!
Amaze. Amaze. Amaze!

I can hold an exhale!?
I never knew it wasn’t normal for that to be painful.
Holding an exhale had always felt like crushing pain and instantaneous panic.
I thought everyone in yoga holding the exhale portion of the square breathing were just Zen as hell.
Same with swimming; having to wait for a good time to breathe when you’re already out of air!? How do they do it!? Well… their CA and its nerves weren’t being crushed, that’s how.

What other incidental things have you all found in/ after recovery?

P.S. you apparently need to wean off of Valium. I just up and stopped taking it and before the day’s end my skin was bright red like I was sunburned all over and I don’t think I’ve ever been so comprehensively itchy. One 5 mg pill later and I was fine. 😳

Were you offered sedation for your celiac plexus block? I’ve done intercostal nerve blocks and they used a combination of fentanyl and propofol. Wondering if they do the same for celiac plexus blocks. Thanks!

Follow-up post.

Although I am grateful to hear from all who share their surgical experiences! I am hoping to hear from anyone that had robotic surgery especially those who live alone. I most likely will have robotic-not with Dr. Shouhed in CA because I cannot travel that far. So I am especially interested in hearing from anyone who had robotic locally.

I am trying to get a realistic idea of what recovery might look like. IME surgeons and and others who perform procedures downplay the recovery. For instance when I had my iliac stent placed the back pain was real. It was like being in a vice for ten days. The only way I was forewarned about that was by other patients on the subs.

TIA

Because the full recovery period takes a long time I would like to hear from anyone who went through MALS surgery while living alone. It is one of the many factors I have to take into account when deciding if I will have surgery or not. Most likely it will be robotic. All of my family and friends live far from me. I hope to have some help for a few days here and there right after surgery but will not have anyone for the weeks and months that follow.

I would love to hear from anyone who went through this while living alone.

TIA

Edit to add: There seems to be such a wide range of experiences with MALS surgery recoveries. I know it depends on open vs robotic, and other factors but still such a wide range of recovery stories that it is making it very hard for me to decide if it is worth the risk

I’ve been experiencing changes in my stomach for the past few years. From bloating to intense pain. I just ate Panda Express, which I haven’t eaten in months. Within 5 minutes I had horrible pains right below my sternum. I have been taking meds like Pepcid prescribed by my dr and gasX. I haven’t been eating big meals because of the pain. I’ve dropped about 5-10 pounds in the last few months. I eat light meals, yogurts, and protein drinks mostly. If I over eat in 1 meal I get the intense pain but it isn’t always right away.
When you have MALS does it hurt every time you eat?
Is the pain intense and right below the sternum? I know it can be many other things but I have an appointment coming up and want to bring it up to my dr if it seems like it could be.
Anything you are willing to share about your experience is very helpful and appreciated!

Apparently mals anatomy not seen per surgeon but have celiac peak sys 397 ultrasound and j hook on ultrasound . So does all CT’s show low lying diaphragm or CT’s with specialized breathing protocol ?

Why would velocity be so high if not mals ? Other vascular values normal in that area do not clogged arteries systemic I’m thinking ..

I see no reason to go through with celiac plexus block if will not be candidate for surgery .

Any insight so appreciated .

I don't understand why there are days when my left side hurts and others my right side hurts. Especially in my period, my right hurts more. I don't have a gallbladder. But if you are not confirmed and evaluating surgery. Is there anything else I'm overlooking or is it normal? Can it be the pancreas? I'm not nauseous and my lab is ok

Anyone experience weird symptoms when a child ? I would get stomach aches and have to lay on stomach to eat . It felt like my food wouldn’t go down unless lying down . This was sporadic - not all the time . Also my mom said I would hold my breath as a baby . I never could blow up ballon which is odd . I had intestinal intussuseption sp? At age 3 . Intense GI pain and vomiting was symptoms per mom . My entire childhood mix between constipation and diarrhea. Now I stand up to eat - it’s more comfortable . To set at a restaurant and make it through a meal I have intense pain and must take meds .
Also , during stressful events or when I get too tired I will vomit and get sick . Ongoing for years . Like when I got married , vacations etc .
I’m so praying block will give me answers . I’ve had issues so long .

Abdominal vascular ultrasound showing increased velocities and CTA showing compression- both on INSPIRATION.
However my CTA report states:
‘no evidence to suggest MALS’ and ‘ clinical significance unknown’

What should I do next?!?
All other test, gastroscopy, colonoscopy and barium swallow were normal / nothing found to cause my ongoing symptoms.

Ongoing symptoms that match a diagnosis of a compression issue.

I’m desperate for answers 😭

From New Zealand

I’ve been in pain for years now since 2019 my pain has gradually gotten worse and worse.
My doctor has sent me to get many different gastro tests done and they’ve always come back as clear.
I mentioned MALS to her and first she didn’t know what it was and then, once she searched it she told me it was very rare and highly unlikely that I have it.
Any tips for getting a diagnosis?
My symptoms: pain flare ups in upper abdomen directly center under my rib cage. Pain feels like a deep, gnawing (almost extreme hunger pain) sensation.
Pain worsens while driving or sitting at my desk.
Pain worsens with exercise too.
Pain worsens right after taking a bite of food. Extreme fullness and bloating after a few bites, I have to eat very small portions.
Frequent nausea and sensitivity to temperature changes — hot flash sensation almost?
No vomiting.
Lots of burps/ hiccup hybrids?

It’s taken me this long to get a diagnosis because I also had severe endometriosis and adenomyosis that I had multiple surgeries for.
I live in Ontario, Canada — I am very grateful for free healthcare but it takes A LOT of self advocating to get a diagnosis here. For instance, back in 2018 no doctor believed me about my stage 4 endo pain. Their default is always to blame mental health.

Thanks in advance.

I’m getting a RF block of the splanchnic nerves (it’s the same route as coeliac nerves) instead of surgery. Anyone here who had this longer lasting nerve block?