Surgery for Vascular Abnormality Lets Young Women Eat Again

Just trying to eat a bagel would cause Jenna Mosconi, 18, of Libertyville, intense abdominal pain. At first, it was puzzling, but when the pain persisted, it became scary for Jenna and her family that she had a bad stomach ache every time she ate.

A few towns over in Long Grove, Alexis Silvers, 19, had the same symptoms and was losing an alarming amount of weight.

Alexis Silvers and Jenna Mosconi

Both were eventually diagnosed with median arcuate ligament syndrome (MALS), a little-known vascular disorder that cripples the digestive system. But the diagnoses came only after an excruciatingly long wait and many dead ends. Some doctors even thought they were intentionally trying to starve themselves to be thin.

However, Jenna, Alexis and their parents knew otherwise. Both wanted to eat but when they tried, they felt like they were having a heart attack. "I practically cried every time I tried because it hurt so much and I was so frustrated," Jenna said.

While the two had never met, they shared a pediatrician who looked for common causes of the young women’s problems. They ruled out reflux disease, gastroenteritis, colitis, infection, and a host of other digestive disorders.

At the doctor’s urging, they went to the University of Chicago Medical Center, where a team of radiologists and surgeons performed advanced multidetector CT angiography scans with 3D imaging. The scans indicated MALS, a condition that occurs when the celiac artery supplying blood to the digestive tract is misshapen, cutting off blood flow necessary for digestion.

Donald Liu, MD, PhD, (far right) meets with Alexis and her mom, and Jenna and her dad.

Radiologist Jonathan Lorenz, MD, associate professor of radiology, identified the malformed artery, shaped like a crinkled hose. Vascular surgeon Christopher Skelly, MD, assistant professor of surgery, determined that it should be corrected surgically and turned to Donald Liu, MD, PhD, chief surgeon at Comer Children's Hospital at the University of Chicago, to perform both procedures.

Instead of the standard nine-inch cut across the abdomen, Liu performed delicate laparoscopic surgery through a few tiny incisions, cutting the ligament so it no longer crushes the blood vessel. The blood vessel sprang back to the correct shape by the end of the surgery and blood flow returned to normal. This restored the young women’s ability to eat, leaving them with barely visible scars.

Recovery began almost instantaneously and they were back with their family and friends within a week.

MALS may not be rare, "just rarely diagnosed," Liu said. Isolated cases of MALS have been identified over the years, but Liu thinks the condition might be revealing itself more now because of sophisticated imaging techniques that make it easier to spot.

Surgical treatment of MALS has been recommended mostly for older patients. However, surgeons like Liu and Skelly are starting to see more young patients debilitated by the condition, who would benefit from surgery. He adds that young adults and teenagers might be particularly susceptible to MALS when they go through growth spurts.

"I think this is something we need to look for when all other test results check out OK," Liu said. "I don't think it is a coincidence that it’s happening to this age group. We need to take a closer look at why."

Jenna and Alexis recently met when they returned for follow-up exams. Both got clean bills of health. They compared MALS horror stories and relief that this ordeal is behind them. They are now enjoying their college years, and eating the good foods they love.

Learn More

• WLS-TV aired a story about the girls' struggle with MALS. Visit the site to view two videos -- the Healthbeat Report and an extended interview with pediatric surgeon Donald Liu, MD, PhD.
• The Chicago Tribune also featured the story.