MALS, previously known as Dunbar syndrome or coeliac artery compression syndrome, is a rare and controversial cause of occlusive chronic mesenteric ischaemia which leads to postprandial abdominal pain, nausea and vomiting and weight loss.
MALS is defined as the symptomatic compression of the coeliac artery by the median arcuate ligament (MAL), which is a fibrous arch uniting the diaphragmatic crura. The exact prevalence of MALS is unknown, but compression of the coeliac artery by the MAL is present in 3.4-7.3% of asymptomatic patients in whom imaging is performed for other indications.
Compression of the coeliac artery by the MAL is frequently observed in individuals with a high origin of the coeliac from the aorta or a lower insertion of the MAL. Since the position of the diaphragm and thus the MAL changes during respiration, the severity of coeliac artery compression varies. Compression is most severe during maximal expiration. MALS is more prevalent in young women (4 female: 1 male) and in patients with a low BMI.
Diagnosis is made based on symptoms + CT or MR angiogram and treatment involves surgical release of the MAL.
Taken from the European guidelines for mesenteric ischaemia - a recommended read!
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