MALS. Why does my stomach hurt so much? let’s talk about Median Arcuate Ligament Syndrome also known as Dunbar syndrome

Have you ever had bad stomach pain, especially after eating? Not just the kind that goes away with a nap or some water—pain that keeps coming back and feels deep inside your belly. If so, you’re not alone. Some people feel this way because of something called Median Arcuate Ligament Syndrome, or MALS for short also known as Dunbar Syndrome

Let’s break it down together!

What Is Median Arcuate Ligament Syndrome?

Inside your body, there’s a strong band of tissue called the median arcuate ligament. This ligament sits just above your stomach and helps hold your body together. It’s supposed to sit up high and leave space for important things like your celiac artery and celiac plexus—a group of nerves that help control your stomach and other nearby organs.

But in some people, this ligament is too low, and it presses down on the celiac plexus and sometimes the artery too. That’s where the trouble starts. Most of the pain is from compression of the celiac plexus.

Why Does It Hurt?

The celiac plexus is like a bundle of electric wires (nerves) that send signals to and from your stomach, liver, pancreas, and other organs. When the ligament presses on this nerve bundle, it’s like stepping on a bunch of wires—the signals get all mixed up and send pain messages to your brain, even when nothing else is wrong.

That’s why people with MALS often feel:

• Sharp or burning stomach pain
• Pain that gets worse after eating
• Nausea or feeling full too fast
• Losing weight without trying (because eating hurts!)
• It feels better lying on the left side or on your stomach

It’s not all in their heads. It’s real pain coming from squished nerves.

How do doctors know it’s MALS?

Doctors use imaging tests like ultrasound, CT scans, or MRIs to look at the area. Sometimes they check blood flow too, to see if the artery is being squeezed. They might also give nerve blocks to test if the pain is coming from the celiac plexus.

What can be done?

If MALS is really causing trouble, doctors may suggest:

• Nerve blocks to calm the celiac plexus
• Surgery to move or cut the ligament and remove the celiac plexus.

The goal is always to relieve the pain and help people eat and live normally again.

‍

1. Horton, K. M., Talamini, M. A., & Fishman, E. K. (2005). Median arcuate ligament syndrome: evaluation with CT angiography. Radiographics, 25(5), 1177–1182. https://doi.org/10.1148/rg.255045142
2. Jimenez, J. C., Harlander-Locke, M. P., & Dutson, E. P. (2012). Open and laparoscopic treatment of median arcuate ligament syndrome. Journal of Vascular Surgery, 56(3), 869–873.
3. Duffy, A. J., Panait, L., Eisenberg, D., Bell, R. L., Roberts, K. E., & Sumpio, B. E. (2009). Management of median arcuate ligament syndrome: A new paradigm. Annals of Vascular Surgery, 23(6), 778–784.
4. Mak, G. Z., Speaker, C., Anderson, K. L., Stiles-Shields, C., Radtke, A., Gamboa, A., & Gosain, A. (2020). Pediatric median arcuate ligament syndrome: Surgical outcomes and quality of life. Journal of Pediatric Surgery, 55(3), 426–430.

‍