High Incidence of Celiac Axis Narrowing in Asymptomatic Individuals

Levin, David C.; Baltaxe, Harold A.

doi:10.2214/ajr.116.2.426

Cited by 68 publications

(19 citation statements)

References 9 publications

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“…It was observed that stenosis of the celiac trunk by the arcuate ligament presents different percentages of stenosis of luminal diameter, considered to be mild (less than 50%), moderate (50 to 75%), or severe (greater than 75%) (Colapinto et al). In some cases, the percentage of the stenotic area is greater than 50% (Koikkalainen & Köhler, 1971;Levin & Baltaxe, 1972;Szilagyi et al;Ducellier et al;Ghosn et al, 1982;Thevenet et al, 1985;Mensink et al;Trinidad -Hernandez et al), in others less than 50% (Szilagyi et al), in others still 50% (Lord & Tracy, 1980;Loffeld et al) or total (Rubush, 1970;Cornell;Ghosn et al;Loffeld et al;Lawson & Ochsner;Jaik et al, 2007).…”

Section: Relationship Between Body Posture and Painmentioning

confidence: 99%

A Review on the Celiac Trunk Compression Syndrome: Some Anatomic Clinical-Surgical Aspects

Petrella

Prates

2008

Int. J. Morphol.

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Section: Relationship Between Body Posture and Painmentioning

confidence: 99%

A Review on the Celiac Trunk Compression Syndrome: Some Anatomic Clinical-Surgical Aspects

Petrella

Prates

2008

Int. J. Morphol.

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“…8 However, 24% of cases with this syndrome are considered to be asymptomatic and about 50% of them do not show stenosis of the CA by angiography. 6,9 Although we saw no evidence of celiac axis compression syndrome in our patient, we postulate that the mechanisms of injury in our patient occurred as follows: (1) the sudden impact to the abdomen caused the increase in intra-abdominal pressure and the rapid compulsory elevation of the diaphragm; (2) the rapid elevation of the diaphragm caused the compression of the CA by the MALO. This elevation also caused simultaneous compression of the CA by the celiac neural plexus; and (3) the significant damage to the origin of the CA occurred transiently and this damage caused the final intimal CA injury.…”

Section: Discussionmentioning

confidence: 54%

A Case of Isolated Celiac Axis Injury by Blunt Abdominal Trauma

Linuma¹,

Yamazaki²,

Hirose³

et al. 2006

The Journal of Trauma: Injury, Infection, and Critical Care

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A lthough blunt abdominal trauma is common, injury to the celiac axis (CA) is a rare occurrence, but with significant mortality. This report describes and discusses the presentation and management of one patient with an isolated CA injury in context with the literature. CASE REPORTA 39-year-old, previously healthy, man with no history of trauma was transferred from a referring institution after suffering direct compression from the tailgate of a cargo truck. On presentation to the emergency department, the patient complained of severe epigastric pain but no superficial injury was observed. A physical examination revealed a heart rate of 70 beats per minute, a systolic blood pressure of 92 mm Hg, severe epigastric tenderness with muscle guarding and an absence of bowel sounds. Laboratory findings on admission revealed an elevated white blood cell count of 24.2 ϫ 10 3 L aspartate aminotransferase of 347 lU/L, alanine aminotransferase of 347 IU/L, and lactate dehydrogenase of 1035 IU/L. There was no anemia or elevation of serum amylase level observed.Computed tomography revealed a large midline retroperitoneal hematoma in the supramesocolic area. The superior mesenteric artery could be visualized. However, CA could not be visualized from its origin despite extravasation around the CA. Therefore, a CA injury was suspected (Fig. 1). Subsequent abdominal angiography demonstrated that the CA terminated abruptly after its origin and celiac branches were visualized via superior mesenteric artery's collaterals (Fig. 2). As no other active bleeding was observed, an isolated CA injury was diagnosed. This finding suggested an intimal injury of the CA by blunt injury. An intra-aortic balloon occlusive catheter (AISIN SEIKI Co., Ltd., Aichi, Japan) was inserted via the right femoral artery and the balloon was placed above the CA without inflation, in case of re-bleeding during the subsequent surgery.During surgery, the left femoral artery and vein were initially exposed and taped in preparation for the possible need of extracorporeal circulation. This procedure was performed to preserve the infra-celiac aortic circulation in case cross clamping of the abdominal aorta during subsequent surgery become necessary. Fortunately, we did not need to inflate the intra-aortic balloon or to place the patient on extracorporeal circulation thereafter.A left-side thoracotomy and transection of the left diaphragm and upper laparotomy was performed. The aortic hiatus of the diaphragm was also transected to obtain sufficient exposure of the proximal aorta of the CA. At this time, medial mobilization of all left-sided intra-abdominal viscera was performed for visualization of the entire abdominal aorta. After that, the aorta was isolated and tapes were placed around the distal and proximal sides of the CA, in preparation for the cross clamping of the aorta. After removal of the hematoma, a careful dissection of the dense plexus of neural tissues and lymphatics was performed. A minor tear of the celiac trunk was visualized and the celiac trunk wa...

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“…5 Celiac artery stenosis often occurs due to extrinsic compression by MAL. [13][14][15] Such stenosis can cause characteristic clinical features (eg, postprandial abdominal pain, weight loss) referred to as MAL syndrome 3,5,16 ; however, most cases of such stenosis are asymptomatic, as were our two cases. MAL compression has been diagnosed angiographically.…”

Section: Discussionmentioning

confidence: 61%

Celiac artery dissection seen with ruptured pancreaticoduodenal arcade aneurysms in two cases of celiac artery stenosis from compression by median arcuate ligament

Watanabe

Kohtake

Furui

et al. 2012

Journal of Vascular Surgery

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We report two cases of ruptured pancreaticoduodenal arcade aneurysms that were successfully treated by embolotherapy. In these cases, contrast-enhanced computed tomography, sagittal reformed images, and angiography revealed celiac artery stenoses due to compression by the median arcuate ligament. Computed tomography also showed acute localized dissection in the distal celiac axis, suggesting that aneurysmal rupture had occurred immediately after development of the dissection. When unruptured pancreaticoduodenal arcade aneurysms are identified in the context of celiac artery dissection, the possibility of rupture may be high and requires strict observation and consideration of embolotherapy.

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High Incidence of Celiac Axis Narrowing in Asymptomatic Individuals

Cited by 68 publications

References 9 publications

A Review on the Celiac Trunk Compression Syndrome: Some Anatomic Clinical-Surgical Aspects

A Review on the Celiac Trunk Compression Syndrome: Some Anatomic Clinical-Surgical Aspects

A Case of Isolated Celiac Axis Injury by Blunt Abdominal Trauma

Celiac artery dissection seen with ruptured pancreaticoduodenal arcade aneurysms in two cases of celiac artery stenosis from compression by median arcuate ligament

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