Reversible Gastroparesis: Functional Documentation of Celiac Axis Compression Syndrome and Postoperative Improvement

Abstract

Celiac axis compression syndrome has generated much controversy since its original description in 1963. The main symptoms are postprandial epigastric abdominal pain, regurgitation of undigested food, and weight loss, all of which are caused by gastric ischemia from impingement of the celiac axis by the median arcuate ligament of the diaphragm. These symptoms are seen in other common disorders such as chronic mesenteric ischemia and gastroparesis. This makes the diagnosis of celiac axis compression syndrome a true challenge for the clinician. We present data on three patients successfully treated. The pre- and postoperative studies clearly demonstrate a resolution of the condition. The duplex ultrasound images clearly show variable compression on the celiac axis. The angiogram presented shows a classic image of the disease. A review of the data has enabled us to develop an algorithm for the diagnosis of this disease.

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

“…Several authors have observed that this disorder mainly affects young females, between 20 and 50 years old (Dunbar et al;Marable et al, 1966;Lord et al, 1968;Cormier & De La Fontaine, 1970;Warter et al, 1970a;Loffeld et al, 1995). The femalemale ratio is 4:1 (Trinidad-Hernandez et al, 2006). Age can eliminate the diagnosis of mesenteric arterial insufficiency of atherosclerotic origin (Marable et al, 1966) and the predominant action of the atheroma (Warter et al, 1970a).…”

“…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).…”

“…Noninvasive diagnostic tests. The grade of stenosis, the systolic and diastolic velocities of flow in the celiac trunk and branches and narrowing, can be evaluated by the use of noninvasive tests: doppler ultrasonography (Trinidad-Hernandez et al;Farma & Hoffman, 2007;Foertsch et al;Jaik et al;Tseng et al), digital subtraction angiography (Desmond & Robert, 2004;Mensink et al;Foertsch et al;Tseng et al), spiral computed tomography (CT) angiography (Baldassarre et al), multislice CT (Karaban et al), multidetector CT angiography (Farma & Hoffman;Ilica et al, 2007;Tseng et al), magnetic resonance angiography (Dordoni et al, 2002;Foertsch et al;Gloviczki & Duncan, 2007).…”

Microbial diversity structure in acetate single chamber microbial fuel cell for electricity generation

“…cytochromes or forming nanowire (pili) [23], [24], [25], [26]. Microbial community that able to release electrons from degradable substrates in addition to consume an easily oxidizable organic substrates are very t crucial feature that have to be considered [27], [28], [29]. In the cathodic electrode, an oxidant is being reduced water molecules.…”

Laparoscopic treatment of median arcuate ligament syndrome

“…The clinical manifestations after surgery are abdominal pain (80%), weight loss (48%), an abdominal vascular murmur (35%), nausea (9.7%), and diarrhea (7.5%) (5). The complications of MALS include gastroparesis and pancreatic duodenal aneurysm, etc., the mechanism of which includes longterm chronic ischemia, development of collaterals, and a long-term extensive decrease in blood flow (6)(7)(8). The diagnosis of MALS requires clinical manifestations and imaging studies and ruling out other causes that may lead to similar symptoms.…”