January 21st, 2020, after calling family friends and coworkers and my mom’s entire contact list, research led my parents and I to a vascular surgeon in Connecticut. Mind you I skipped two doctors before that because they just had no answers for us. Anyways, I met Dr Hsu, a vascular expert in Median Arcuate Ligament Syndrome. Having joined a facebook group and learned a lot about his studies, I felt the need to see him about my scans and test results. He told me very sternly that I had 80% compression of my celiac artery to which meant the median arcuate ligament specifically was pushing down on my aorta causing an indentation to which my epigastric pain came from. In terms of definition Median arcuate ligament syndrome (MALS) is a rare entity characterized by extrinsic compression of the celiac artery and symptoms of postprandial epigastric pain, nausea, vomiting, and weight loss mimicking mesenteric ischemia. This was a lot to digest, literally. Most doctors believe this started at birth. Dr Hsu feels in MALS patients, the diaphragm is too low, causing the median arcuate ligament to compress the celiac artery. The compression also affects the nerves causing inflammation and sends pain signals to the brain. Over time, it will affect a bundle of sensory nerves in the celiac ganglion area causing change in blood flow from the pressure and increase in inflammation. This creates symptoms such as sudden weight loss, nausea with or without vomiting, epigastric pain, and early satiety. Patients like myself are unable to eat due to the pain and nausea and begin to lose weight.
Later on that day, I was told over the phone to get a Gastric Emptying Study which involves eating nuclear eggs and taking images of my stomach. To which I had delayed gastric emptying for the first three hours and normal at the fourth. Fortunately I was told I do not have a high chance of Gastroparesis. I later followed up with a new Gastroenterologist finally after convincing my mom it was time to leave that guy once and for all.
