Median Arcuate Ligament Syndrome: The Past and the Future.

Median arcuate ligament syndrome (MALS) is a rare condition characterized by chronic abdominal pain, nausea, vomiting, and weight loss. Symptoms of MALS are nonspecific and overlap with those of other, more common, disorders of gut-brain interaction (DGBIs). A duplex ultrasound is the recommended first diagnostic modality after clinical history and examination, and after ruling out DGBIs. Specific protocols for this are recommended to get accurate results. For true mesenteric ischemia caused by MALS, surgery may be helpful to decompress the celiac artery. Benefits are limited, and the clinician should ensure that all other considerations, including mental health, have been assessed.