COVID-19-Associated Median Arcuate Ligament Syndrome
Benjamin O Brandeis1, Josiah Hardy1, Stephen Kavic2
1School of Medicine, University of Maryland, Baltimore, MD, USA.
The American Surgeon
|June 17, 2025
Summary
Median arcuate ligament syndrome (MALS) symptoms, including abdominal pain, may develop post-COVID-19 infection. Surgical intervention and assessment for vascular compressions are recommended for symptomatic patients.
Area of Science:
- Vascular Surgery
- Gastroenterology
- Infectious Diseases
Background:
- Median arcuate ligament syndrome (MALS) involves celiac artery compression, causing symptoms like epigastric pain.
- The link between COVID-19 infection and MALS development is not well understood.
- Identifying triggers for MALS symptom onset is crucial for patient management.
Purpose of the Study:
- To investigate the potential association between COVID-19 infection and the onset of MALS symptoms.
- To describe the clinical presentation and treatment outcomes of patients with post-COVID-19 MALS.
- To evaluate the efficacy of surgical intervention for MALS in this patient cohort.
Main Methods:
- Retrospective chart review of 7 patients diagnosed with MALS.
- Analysis of symptom onset in relation to preceding COVID-19 infection.
- Assessment of treatment response, including celiac plexus block and surgical intervention.
Main Results:
- Seven patients developed MALS symptoms approximately one month after COVID-19 infection.
- Abdominal pain was the primary symptom, temporarily relieved by celiac plexus block.
- Most patients presented with multiple vascular compressions.
- Surgical intervention led to symptomatic improvement.
Conclusions:
- COVID-19 infection may be a potential trigger for symptomatic MALS.
- Patients with post-COVID-19 MALS should be evaluated for surgical candidacy.
- Comprehensive assessment for associated vascular compressions is essential for effective MALS management.
