# Median Arcuate Ligament Syndrome — GCMD Library living collection

Everything in the library about median arcuate ligament syndrome — built automatically from dossiers that name it.

Updated: n/a · 3 episodes · 74 cited statements

## Episodes
### Surgical Management
- [Robotic-Assisted Release of the Median Arcuate Ligament for Pediatric MALS](https://origin-library.globalcastmd.com/watch/robotic-assisted-release-of-the-median-arcuate-ligament-for-pediatric-mals-1290) — video · 4:51 · [machine version](https://origin-library.globalcastmd.com/watch/robotic-assisted-release-of-the-median-arcuate-ligament-for-pediatric-mals-1290.md)

### Case-Based Learning
- [MALS with Trinity](https://origin-library.globalcastmd.com/watch/mals-with-trinity-11938) — video · 7:09 · [machine version](https://origin-library.globalcastmd.com/watch/mals-with-trinity-11938.md)

### In-Depth Reviews
- [Persistent Abdominal Pain - Median Arcuate Ligament Syndrome: Update Course 2014](https://origin-library.globalcastmd.com/watch/persistent-abdominal-pain-median-arcuate-ligament-syndrome-update-course-2014-657) — video · 22:32 · [machine version](https://origin-library.globalcastmd.com/watch/persistent-abdominal-pain-median-arcuate-ligament-syndrome-update-course-2014-657.md)

## Chapters
- [0:00](https://origin-library.globalcastmd.com/watch/persistent-abdominal-pain-median-arcuate-ligament-syndrome-update-course-2014-657?t=0) Introduction to Median Arcuate Ligament Syndrome and Laparoscopic Technique (Ep 1)
- [8:47](https://origin-library.globalcastmd.com/watch/persistent-abdominal-pain-median-arcuate-ligament-syndrome-update-course-2014-657?t=527) Skepticism About Pathophysiology and Need for Controlled Data (Ep 1)
- [11:23](https://origin-library.globalcastmd.com/watch/persistent-abdominal-pain-median-arcuate-ligament-syndrome-update-course-2014-657?t=683) Patient Selection, Outcomes, and Risk-Benefit Discussion (Ep 1)
- [18:23](https://origin-library.globalcastmd.com/watch/persistent-abdominal-pain-median-arcuate-ligament-syndrome-update-course-2014-657?t=1103) General Approach to Chronic Abdominal Pain in Children (Ep 1)
- [0:03](https://origin-library.globalcastmd.com/watch/robotic-assisted-release-of-the-median-arcuate-ligament-for-pediatric-mals-1290?t=3) Median Arcuate Ligament Syndrome: Pathophysiology and Diagnosis (Ep 2)
- [1:02](https://origin-library.globalcastmd.com/watch/robotic-assisted-release-of-the-median-arcuate-ligament-for-pediatric-mals-1290?t=62) Robotic Surgical Approach and Initial Dissection (Ep 2)
- [2:25](https://origin-library.globalcastmd.com/watch/robotic-assisted-release-of-the-median-arcuate-ligament-for-pediatric-mals-1290?t=145) Median Arcuate Ligament Division and Circumferential Dissection (Ep 2)
- [3:59](https://origin-library.globalcastmd.com/watch/robotic-assisted-release-of-the-median-arcuate-ligament-for-pediatric-mals-1290?t=239) Outcomes and Complication Management (Ep 2)
- [0:00](https://origin-library.globalcastmd.com/watch/mals-with-trinity-11938?t=0) Case presentation and patient positioning (Ep 3)
- [1:00](https://origin-library.globalcastmd.com/watch/mals-with-trinity-11938?t=60) Initial dissection and gastropatic ligament opening (Ep 3)
- [3:00](https://origin-library.globalcastmd.com/watch/mals-with-trinity-11938?t=180) Hepatic artery dissection and management of inflammatory nodes (Ep 3)
- [5:00](https://origin-library.globalcastmd.com/watch/mals-with-trinity-11938?t=300) Celiac plexus and nerve fiber division (Ep 3)
- [6:00](https://origin-library.globalcastmd.com/watch/mals-with-trinity-11938?t=360) Median arcuate ligament division and completion (Ep 3)

## Statements
Every statement is attributed, typed, and timestamped; the link is the citation.
- Median arcuate ligament syndrome is a chronic abdominal pain syndrome characterized by epigastric pain, nausea, and vomiting. (clinical) [Ep 2 · 0:10](https://origin-library.globalcastmd.com/watch/robotic-assisted-release-of-the-median-arcuate-ligament-for-pediatric-mals-1290?t=10)
- The pain in MALS is usually worse after meals and eventually leads to anorexia and weight loss. (clinical) [Ep 2 · 0:18](https://origin-library.globalcastmd.com/watch/robotic-assisted-release-of-the-median-arcuate-ligament-for-pediatric-mals-1290?t=18)
- MALS is a diagnosis of exclusion hypothesized to be caused by compression of the celiac artery and celiac plexus by the median arcuate ligament, a fibrous band at the intersection of the left and right diaphragmatic crura. (clinical) [Ep 2 · 0:25](https://origin-library.globalcastmd.com/watch/robotic-assisted-release-of-the-median-arcuate-ligament-for-pediatric-mals-1290?t=25)
- Multiple imaging modalities are useful in identifying celiac compression for MALS diagnosis, including CTA, MRA, and conventional angiography. (clinical) [Ep 2 · 0:39](https://origin-library.globalcastmd.com/watch/robotic-assisted-release-of-the-median-arcuate-ligament-for-pediatric-mals-1290?t=39)
- Dynamic flow changes in MALS can be evaluated by duplex ultrasound, with flow restriction worsening during expiration due to changes in the position of the diaphragm. (clinical) [Ep 2 · 0:51](https://origin-library.globalcastmd.com/watch/robotic-assisted-release-of-the-median-arcuate-ligament-for-pediatric-mals-1290?t=51)
- Due to the presence of a mechanical constriction, the treatment for MALS is surgical release. (clinical) [Ep 2 · 1:02](https://origin-library.globalcastmd.com/watch/robotic-assisted-release-of-the-median-arcuate-ligament-for-pediatric-mals-1290?t=62)
- Robotic MALS surgery offers improved 3-dimensional visualization, flexibility and end or wrist motion for challenging angles, elimination of tremor, and scaling of motion for fine dissection in a limited space. (opinion) [Ep 2 · 1:08](https://origin-library.globalcastmd.com/watch/robotic-assisted-release-of-the-median-arcuate-ligament-for-pediatric-mals-1290?t=68)
- In robotic MALS surgery, dissection is approached through a window in the lesser omentum. (clinical) [Ep 2 · 1:27](https://origin-library.globalcastmd.com/watch/robotic-assisted-release-of-the-median-arcuate-ligament-for-pediatric-mals-1290?t=87)
- Early identification of the celiac trifurcation is a key step in robotic MALS surgery. (clinical) [Ep 2 · 1:33](https://origin-library.globalcastmd.com/watch/robotic-assisted-release-of-the-median-arcuate-ligament-for-pediatric-mals-1290?t=93)
- Ganglionectomy is performed as encountered during the dissection of fibrous bands and perivascular connective tissue in MALS surgery. (clinical) [Ep 2 · 1:41](https://origin-library.globalcastmd.com/watch/robotic-assisted-release-of-the-median-arcuate-ligament-for-pediatric-mals-1290?t=101)
- Dissection in MALS surgery proceeds from distal to proximal towards the origin of the celiac axis. (clinical) [Ep 2 · 1:54](https://origin-library.globalcastmd.com/watch/robotic-assisted-release-of-the-median-arcuate-ligament-for-pediatric-mals-1290?t=114)
- Some MALS cases require dissection of right crural fibers to reach the base of the celiac artery. (clinical) [Ep 2 · 2:06](https://origin-library.globalcastmd.com/watch/robotic-assisted-release-of-the-median-arcuate-ligament-for-pediatric-mals-1290?t=126)
- Division of the median arcuate ligament can be accomplished by standard hook electrocautery, bipolar energy devices, or a vessel sealing device. (clinical) [Ep 2 · 2:25](https://origin-library.globalcastmd.com/watch/robotic-assisted-release-of-the-median-arcuate-ligament-for-pediatric-mals-1290?t=145)
- Residual celiac trunk tortuosity may persist after initial median arcuate ligament release. (clinical) [Ep 2 · 2:54](https://origin-library.globalcastmd.com/watch/robotic-assisted-release-of-the-median-arcuate-ligament-for-pediatric-mals-1290?t=174)
- Dissection must continue along the anterior wall of the aorta down to the pre-adventitial plane from caudal to cranial for around 4 centimeters. (clinical) [Ep 2 · 3:01](https://origin-library.globalcastmd.com/watch/robotic-assisted-release-of-the-median-arcuate-ligament-for-pediatric-mals-1290?t=181)
- Circumferential dissection down to the pre-adventitial plane must be accomplished around the origins of the left gastric artery, the common hepatic artery, the splenic artery, and the celiac trunk. (clinical) [Ep 2 · 3:19](https://origin-library.globalcastmd.com/watch/robotic-assisted-release-of-the-median-arcuate-ligament-for-pediatric-mals-1290?t=199)
- Significant improvement in celiac trunk appearance is observed after complete circumferential dissection. (clinical) [Ep 2 · 3:59](https://origin-library.globalcastmd.com/watch/robotic-assisted-release-of-the-median-arcuate-ligament-for-pediatric-mals-1290?t=239)
- Following proper surgical technique, median arcuate ligament release can be accomplished safely in the pediatric population with good results. (opinion) [Ep 2 · 4:08](https://origin-library.globalcastmd.com/watch/robotic-assisted-release-of-the-median-arcuate-ligament-for-pediatric-mals-1290?t=248)
- MALS surgery carries the risk of injury to important vessels due to proximity to critical anatomy. (clinical) [Ep 2 · 4:18](https://origin-library.globalcastmd.com/watch/robotic-assisted-release-of-the-median-arcuate-ligament-for-pediatric-mals-1290?t=258)
- With the exposure and visualization provided by the robotic approach, vascular complications in MALS surgery can be addressed minimally invasively. (opinion) [Ep 2 · 4:25](https://origin-library.globalcastmd.com/watch/robotic-assisted-release-of-the-median-arcuate-ligament-for-pediatric-mals-1290?t=265)
- An avulsion of a small aortic branch during MALS surgery can be controlled with steady pressure applied via suction irrigator, temporized with a clip, and repaired with pledgeted sutures intracorporeally. (clinical) [Ep 2 · 4:35](https://origin-library.globalcastmd.com/watch/robotic-assisted-release-of-the-median-arcuate-ligament-for-pediatric-mals-1290?t=275)
- Median arcuate ligament syndrome pathogenesis is unknown; unclear whether mesenteric ischemia or neurogenic stimulation from nerve compression is the mechanism. (clinical) [Ep 1 · 0:00](https://origin-library.globalcastmd.com/watch/persistent-abdominal-pain-median-arcuate-ligament-syndrome-update-course-2014-657?t=0)
- In adolescents with MALS, abdominal pain is more frequently post-exercise rather than postprandial, unlike the adult presentation. (clinical) [Ep 1 · 1:00](https://origin-library.globalcastmd.com/watch/persistent-abdominal-pain-median-arcuate-ligament-syndrome-update-course-2014-657?t=60)
- MALS is a diagnosis of exclusion requiring extensive negative workup including upper and lower endoscopy, CT enterography, nuclear medicine studies, and imaging. (clinical) [Ep 1 · 2:00](https://origin-library.globalcastmd.com/watch/persistent-abdominal-pain-median-arcuate-ligament-syndrome-update-course-2014-657?t=120)
- Dynamic CT angiography with both inspiratory and expiratory phases is critical for diagnosing MALS anatomically. (clinical) [Ep 1 · 3:00](https://origin-library.globalcastmd.com/watch/persistent-abdominal-pain-median-arcuate-ligament-syndrome-update-course-2014-657?t=180)
- Duplex ultrasound celiac artery velocity above 300 cm/s is suggestive of MALS; different labs use different thresholds. (clinical) [Ep 1 · 4:00](https://origin-library.globalcastmd.com/watch/persistent-abdominal-pain-median-arcuate-ligament-syndrome-update-course-2014-657?t=240)
- Pediatric MALS literature consists of only two small studies showing safety in experienced centers and some quality-of-life improvement in highly selected patients. (epidemiological) [Ep 1 · 5:00](https://origin-library.globalcastmd.com/watch/persistent-abdominal-pain-median-arcuate-ligament-syndrome-update-course-2014-657?t=300)
- Laparoscopic MALS release involves millimeter-by-millimeter division of median arcuate ligament fibers staying anterior on the aorta to avoid vessels; the compressed artery is not visible until partial release. (clinical) [Ep 1 · 6:00](https://origin-library.globalcastmd.com/watch/persistent-abdominal-pain-median-arcuate-ligament-syndrome-update-course-2014-657?t=360)
- Arterial stenosis requiring patch repair occurs in adults over 40–45 years but not in adolescents with MALS. (clinical) [Ep 1 · 7:00](https://origin-library.globalcastmd.com/watch/persistent-abdominal-pain-median-arcuate-ligament-syndrome-update-course-2014-657?t=420)
- MALS patients should be plugged into pain service or psychology before surgery for postoperative support, often done in conjunction with gastroenterology. (clinical) [Ep 1 · 8:00](https://origin-library.globalcastmd.com/watch/persistent-abdominal-pain-median-arcuate-ligament-syndrome-update-course-2014-657?t=480)
- Laparoscopic MALS release is safe with fast recovery (discharge by next day) assuming no intraoperative complications. (clinical) [Ep 1 · 8:00](https://origin-library.globalcastmd.com/watch/persistent-abdominal-pain-median-arcuate-ligament-syndrome-update-course-2014-657?t=480)
- Quality of life improves in the short term after MALS release, but long-term data are lacking. (clinical) [Ep 1 · 8:00](https://origin-library.globalcastmd.com/watch/persistent-abdominal-pain-median-arcuate-ligament-syndrome-update-course-2014-657?t=480)
- Intraoperative ultrasound during MALS release was tried once but not found useful if anatomy is known. (opinion) [Ep 1 · 8:50](https://origin-library.globalcastmd.com/watch/persistent-abdominal-pain-median-arcuate-ligament-syndrome-update-course-2014-657?t=530)
- Getting into the celiac artery during MALS release is a disaster; videos of this complication have been shown at IPEG. (clinical) [Ep 1 · 9:38](https://origin-library.globalcastmd.com/watch/persistent-abdominal-pain-median-arcuate-ligament-syndrome-update-course-2014-657?t=578)
- Historically, many children with chronic abdominal pain improved after appendectomy for a normal appendix, suggesting a placebo or psychological effect. (clinical) [Ep 1 · 10:02](https://origin-library.globalcastmd.com/watch/persistent-abdominal-pain-median-arcuate-ligament-syndrome-update-course-2014-657?t=602)
- There is no data showing MALS release addresses the cause of abdominal pain; it is analogous to the recent increase in cholecystectomy for poor gallbladder emptying in children. (opinion) [Ep 1 · 11:00](https://origin-library.globalcastmd.com/watch/persistent-abdominal-pain-median-arcuate-ligament-syndrome-update-course-2014-657?t=660)
- Children have robust collateral circulation, making it hard to imagine celiac stenosis causes ischemic pain. (clinical) [Ep 1 · 11:23](https://origin-library.globalcastmd.com/watch/persistent-abdominal-pain-median-arcuate-ligament-syndrome-update-course-2014-657?t=683)
- If celiac artery compression is found incidentally in an asymptomatic child, no intervention is indicated. (clinical) [Ep 1 · 11:58](https://origin-library.globalcastmd.com/watch/persistent-abdominal-pain-median-arcuate-ligament-syndrome-update-course-2014-657?t=718)
- All MALS cases at the speaker's institution were done under IRB protocol with prospective data collection and validated quality-of-life questionnaires (87 questions for children, 50 for parents). (clinical) [Ep 1 · 12:30](https://origin-library.globalcastmd.com/watch/persistent-abdominal-pain-median-arcuate-ligament-syndrome-update-course-2014-657?t=750)
- Significant improvement in almost all quality-of-life parameters was seen pre- vs. post-MALS release, but follow-up was limited. (clinical) [Ep 1 · 12:30](https://origin-library.globalcastmd.com/watch/persistent-abdominal-pain-median-arcuate-ligament-syndrome-update-course-2014-657?t=750)
- 75–80% of MALS patients improved after surgery. (clinical) [Ep 1 · 13:01](https://origin-library.globalcastmd.com/watch/persistent-abdominal-pain-median-arcuate-ligament-syndrome-update-course-2014-657?t=781)
- The speaker has performed 21 laparoscopic MALS releases; Don Liu's group in Chicago published 46 cases. (epidemiological) [Ep 1 · 13:23](https://origin-library.globalcastmd.com/watch/persistent-abdominal-pain-median-arcuate-ligament-syndrome-update-course-2014-657?t=803)
- Celiac artery velocity over 300 cm/s on vascular ultrasound indicates significant compression; this can be done without CT and used for postoperative comparison. (clinical) [Ep 1 · 14:36](https://origin-library.globalcastmd.com/watch/persistent-abdominal-pain-median-arcuate-ligament-syndrome-update-course-2014-657?t=876)
- The number of MALS cases at Comer Children's Hospital in Chicago has decreased since Don Liu's death. (epidemiological) [Ep 1 · 15:20](https://origin-library.globalcastmd.com/watch/persistent-abdominal-pain-median-arcuate-ligament-syndrome-update-course-2014-657?t=920)
- Chronic abdominal pain management trends have shifted over time: appendectomy, then cholecystectomy, now MALS release. (opinion) [Ep 1 · 15:20](https://origin-library.globalcastmd.com/watch/persistent-abdominal-pain-median-arcuate-ligament-syndrome-update-course-2014-657?t=920)
- If one celiac artery injury occurs in 100 MALS cases and the child dies on the table, the procedure cannot be justified. (opinion) [Ep 1 · 15:20](https://origin-library.globalcastmd.com/watch/persistent-abdominal-pain-median-arcuate-ligament-syndrome-update-course-2014-657?t=920)
- Operating on a patient with abdominal pain and no identifiable pathology is problematic; adding a scar focuses all future pain on adhesions. (clinical) [Ep 1 · 16:20](https://origin-library.globalcastmd.com/watch/persistent-abdominal-pain-median-arcuate-ligament-syndrome-update-course-2014-657?t=980)
- Patients with chronic abdominal pain 'hang their hats' on any diagnosis offered during workup. (clinical) [Ep 1 · 16:20](https://origin-library.globalcastmd.com/watch/persistent-abdominal-pain-median-arcuate-ligament-syndrome-update-course-2014-657?t=980)
- MALS diagnosis requires both clinical presentation (post-exercise or postprandial pain after extensive negative workup) and anatomic features (stenosis on imaging, elevated celiac velocity). (clinical) [Ep 1 · 17:00](https://origin-library.globalcastmd.com/watch/persistent-abdominal-pain-median-arcuate-ligament-syndrome-update-course-2014-657?t=1020)
- At the speaker's previous lab, celiac velocity threshold was 275 cm/s; at the current lab it is 250 cm/s, recently increased. (clinical) [Ep 1 · 17:00](https://origin-library.globalcastmd.com/watch/persistent-abdominal-pain-median-arcuate-ligament-syndrome-update-course-2014-657?t=1020)
- Thorough informed consent for MALS release includes explaining that being 1 millimeter off can cause disaster, complications, and death; some patients decline after this discussion. (clinical) [Ep 1 · 17:50](https://origin-library.globalcastmd.com/watch/persistent-abdominal-pain-median-arcuate-ligament-syndrome-update-course-2014-657?t=1070)
- In chronic abdominal pain workup, clinicians often 'do enough tests until you find one that's abnormal and then call that the diagnosis.' (opinion) [Ep 1 · 18:33](https://origin-library.globalcastmd.com/watch/persistent-abdominal-pain-median-arcuate-ligament-syndrome-update-course-2014-657?t=1113)
- One surgeon would not take out the appendix in a diagnostic laparoscopy for chronic pain today, believing patients improve from just opening the belly. (opinion) [Ep 1 · 19:34](https://origin-library.globalcastmd.com/watch/persistent-abdominal-pain-median-arcuate-ligament-syndrome-update-course-2014-657?t=1174)
- Diagnostic laparoscopy with appendectomy for chronic abdominal pain (after negative extensive workup) has very low morbidity and can be viewed as another diagnostic test. (clinical) [Ep 1 · 20:20](https://origin-library.globalcastmd.com/watch/persistent-abdominal-pain-median-arcuate-ligament-syndrome-update-course-2014-657?t=1220)
- 70% of children undergoing diagnostic laparoscopy with appendectomy for chronic pain improved, though some had recurrence at 6 months. (clinical) [Ep 1 · 20:20](https://origin-library.globalcastmd.com/watch/persistent-abdominal-pain-median-arcuate-ligament-syndrome-update-course-2014-657?t=1220)
- Diagnostic laparoscopy helps families accept there is no anatomic cause and transition to pain management strategies. (clinical) [Ep 1 · 20:20](https://origin-library.globalcastmd.com/watch/persistent-abdominal-pain-median-arcuate-ligament-syndrome-update-course-2014-657?t=1220)
- Softening stools is the most effective intervention for chronic abdominal pain; nearly all these children have subtle constipation. (clinical) [Ep 1 · 22:12](https://origin-library.globalcastmd.com/watch/persistent-abdominal-pain-median-arcuate-ligament-syndrome-update-course-2014-657?t=1332)
- A 17 year old female with a 1 year history of chronic pain was found to have celiac artery compression and angulation on a CT angio (clinical) [Ep 3 · 0:00](https://origin-library.globalcastmd.com/watch/mals-with-trinity-11938?t=0)
- The procedure used 5 ports, 4 5-millimeter ports and 1 3-millimeter port (clinical) [Ep 3 · 0:45](https://origin-library.globalcastmd.com/watch/mals-with-trinity-11938?t=45)
- The ability to seal and cut safely with no heat spread is key for the entirety of the procedure (opinion) [Ep 3 · 1:00](https://origin-library.globalcastmd.com/watch/mals-with-trinity-11938?t=60)
- Identifying the right crus and where the right and left crus come together are critical for this procedure (clinical) [Ep 3 · 2:00](https://origin-library.globalcastmd.com/watch/mals-with-trinity-11938?t=120)
- There was unusually a large amount of inflammation in this area and a number of enlarged inflammatory nodes (clinical) [Ep 3 · 2:30](https://origin-library.globalcastmd.com/watch/mals-with-trinity-11938?t=150)
- Dissecting off inflamed nodes is critical in identifying the celiac trunk and to prevent inadvertent injury to the hepatic artery (clinical) [Ep 3 · 3:00](https://origin-library.globalcastmd.com/watch/mals-with-trinity-11938?t=180)
- The fibrous tissue in this area seemed to be impinging on the hepatic artery (clinical) [Ep 3 · 3:30](https://origin-library.globalcastmd.com/watch/mals-with-trinity-11938?t=210)
- A vessel loop was placed around the left gastric artery for traction and secured with 5 millimeter clips (clinical) [Ep 3 · 4:00](https://origin-library.globalcastmd.com/watch/mals-with-trinity-11938?t=240)
- It is necessary to divide celiac plexus nerve fibers to fully open up the area around the celiac trunk (clinical) [Ep 3 · 5:00](https://origin-library.globalcastmd.com/watch/mals-with-trinity-11938?t=300)
- All the energy is between the jaws and there is absolutely no heat spread outside of the jaws with the Trinity device (clinical) [Ep 3 · 5:30](https://origin-library.globalcastmd.com/watch/mals-with-trinity-11938?t=330)
- The lack of heat spread allows dissection, sealing, and dividing tissues while resting on the hepatic artery, celiac trunk, stomach, and other structures (clinical) [Ep 3 · 5:30](https://origin-library.globalcastmd.com/watch/mals-with-trinity-11938?t=330)
- The curved jaws allow better orientation to divide the fibers of the right crus and expose the median arcuate ligament (clinical) [Ep 3 · 6:00](https://origin-library.globalcastmd.com/watch/mals-with-trinity-11938?t=360)
- Two-hand dissection greatly enhances the surgery by allowing dissection, grasping tissue, and elevating planes with both hands (opinion) [Ep 3 · 6:00](https://origin-library.globalcastmd.com/watch/mals-with-trinity-11938?t=360)
- As the median arcuate ligament is divided, the celiac trunk expands and fills into view, showing significant compression of the structure (clinical) [Ep 3 · 6:30](https://origin-library.globalcastmd.com/watch/mals-with-trinity-11938?t=390)
- The ligament must be divided up to the insertion of the celiac trunk on the aorta to ensure complete division (clinical) [Ep 3 · 6:30](https://origin-library.globalcastmd.com/watch/mals-with-trinity-11938?t=390)
- The surgery lasted 90 minutes (clinical) [Ep 3 · 7:00](https://origin-library.globalcastmd.com/watch/mals-with-trinity-11938?t=420)
- The patient was discharged to home with complete resolution of her symptoms the following day (clinical) [Ep 3 · 7:00](https://origin-library.globalcastmd.com/watch/mals-with-trinity-11938?t=420)

## Host summaries
Recaps by a host of what the experts said — not the host's own clinical position.
- Cumulative MALS experience among surgeons in the room is very limited: one surgeon did one case, most have done none. — The host summarizing the discussion [Ep 1 · 13:35](https://origin-library.globalcastmd.com/watch/persistent-abdominal-pain-median-arcuate-ligament-syndrome-update-course-2014-657?t=815)
- A senior GI physician observed that Crohn's patients never miss school, while functional abdominal pain patients miss months of school; school attendance is a useful history point. — The host summarizing the discussion [Ep 1 · 21:21](https://origin-library.globalcastmd.com/watch/persistent-abdominal-pain-median-arcuate-ligament-syndrome-update-course-2014-657?t=1281)
- Dr. Clapworthy's rule from 50 years ago: treat chronic abdominal pain with a stool softener (like MiraLAX) for a month; patients almost never returned. — The host summarizing the discussion [Ep 1 · 21:55](https://origin-library.globalcastmd.com/watch/persistent-abdominal-pain-median-arcuate-ligament-syndrome-update-course-2014-657?t=1315)

## Changelog
- Sep 25: 3 items added automatically

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