The Celiac Axis Compression Syndrome

Abstract

An ongoing debate in the literature discusses whether compression of the celiac axis (CA) and/or the superior mesenteric artery (SMA) by the arcuate ligament of the diaphragm may be responsible for a clinical syndrome. Five patients with postprandial epigastric pain and weight loss, with a loud systolic bruit in the epigastric region are described. In 4 cases, no other obvious explanation for the complaints was present except compression of the CA and SMA by the arcuate ligament of the diaphragm as shown on angiography. One patient had cholecystolithiasis. Two patients suffered from thrombosis in the CA with major stenosis of the SMA. In 3 cases, solitary stenosis of the CA was present. In 3 cases, important collateral circulation was seen, and 1 patient had possibly ischemic gastric ulcers indicating the ischemic nature of the complaints. Vascular reconstruction was done in 4 patients. One patient with a stenosis of less than 50% underwent cholecystectomy and was free of complaints thereafter. All other 4 patients were free of complaints after the operation. The CA compression syndrome should be considered in the differential diagnosis of patients with upper abdominal pain, weight loss and a loud systolic bruit in the epigastric region.

Diagnosis and management of splanchnic ischemia

“…In 1972, Szilagyi et al [44] reviewed the entire literature on CA compression syndrome and found no proof of any abnormality of intestinal structure or function that could be attributed to this compression, nor proof that treatment had more than a placebo effect. However, several papers were published with good results for CA decompression operations [45][46][47] . These opinions were challenged recently by our group.…”

Celiac Artery Compression Syndrome in Children, Adolescents, and Young Adults

“…[20][21][22] Some authors perform a dissection of nervous tissue in addition to excision of some parts of the median arcuate ligament. 18 Others rigorously denied even the existence of CACS 23 or reported on lack of long-term pain relief in patients who underwent surgery 24 ; this in contrast to others (3/3 cases, 25 22/25 cases, 26 1/1, 27 and 3/4 surgical cases from 63 diagnosed 7,28 ). A negative summary of long-term results by Geelkerken et al 24 deserves a detailed description: 8 of 11 patients who underwent surgery (3 had no follow-up at all) had follow-up between 15 and 23 years; 3 of 8 had no pain relief as early as 3 months after surgery; and the remaining relapsed after symptom-free intervals of 1 to 20 years.…”

“…25,28 Investigations in larger preadult populations are still lacking. Some controversy in the past might be caused by comparison of incomparable situations (different surgical techniques and histologic details of excised tissue not given).…”

STAGE TREATMENT OF CELIAC TRUNK COMPRESSION SYNDROME (Case report and literature review)

“…Подобный оптимизм и относи тельная простота декомпрессионных операций побудила к поиску еще менее инвазивных мето дик. В последние годы в литературе появились сообщения об успешном применении лапарос копической техники для декомпрессии ЧС [43,44,62,63] и робот ассистированных операций [33]. Однако, если после разделения структур ных элементов диафрагмы и/или периартери альных нервных тканей, вовлеченных в процесс, стенозированный ЧС не восстанавливается до нормального калибра и остается значимый гра диент давления в месте стеноза, требуется реко нструкция этого сегмента путем резекции сте нозированного участка с анастомозом конец в конец или протезирования/ шунтирования или эндартерэктомии.…”