Median arcuate ligament syndrome: When to consider the diagnosis and management options

Median arcuate ligament syndrome (MALS) occurs due to extrinsic compression of the coeliac plexus, leading to postprandial and exercise-induced epigastric pain, nausea, vomiting, food fear and weight loss. Diagnosis can be challenging as up to 25% of the population have radiological compression. However, only 1% of the population have corresponding symptoms. The duration between the onset of symptoms and diagnosis of MALS can extend up to years. Primary care physicians are commonly the first people to encounter patients with MALS and play a vital role in its assessment, diagnosis and management and the coordination of subspecialty care.

The aim of this article is to provide general practitioners with a review of the current literature, summarise a diagnostic pathway and propose a treatment algorithm for MALS.

MALS is a rare cause of debilitating abdominal pain with no single 'rule in test'. It often affects young patients and leads to significant morbidity and poor quality of life. Increased awareness of MALS in the primary care setting allows for earlier consideration and investigation as part of the diagnostic work-up for patients with symptoms of abdominal pain not attributable to more common conditions.