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Celiac artery compression syndrome

Authors
Sherry Scovell, MD, FACS
Allen Hamdan, MD
Section Editors
John F Eidt, MD
Joseph L Mills, Sr, MD
Deputy Editor
Kathryn A Collins, MD, PhD, FACS

INTRODUCTION

Celiac artery compression syndrome is defined as chronic, recurrent abdominal pain related to compression of the celiac artery by the median arcuate ligament. It is also referred to as celiac axis syndrome, median arcuate ligament syndrome, and Dunbar syndrome. It is an uncommon disorder that is characterized clinically by the triad of postprandial abdominal pain, weight loss, and sometimes an abdominal bruit. The diagnosis is often one of exclusion, given the nonspecific symptoms that overlap with other forms of chronic intestinal ischemia. Treatment involves surgical decompression of the celiac axis. Treatment success, which cannot be guaranteed, depends upon appropriate patient selection. Celiac artery decompression can be accomplished using an open or minimally invasive approach, which can either be a standard laparoscopic or a robotic-assisted approach. For some patients, celiac artery revascularization (open, endovascular) may be necessary.

The etiology, clinical features, diagnosis, and treatment of celiac artery compression syndrome will be reviewed here. An overview of other etiologies for acute mesenteric ischemia and chronic mesenteric ischemia is provided separately. (See "Overview of intestinal ischemia in adults" and "Chronic mesenteric ischemia".)

ETIOLOGY AND PATHOPHYSIOLOGY

The etiology and pathophysiology of celiac artery compression syndrome are incompletely understood but may be related to both ischemic and neuropathic mechanisms.

The anatomy of the celiac region (including the median arcuate ligament and its variations [1]) was described long before the relationship between abdominal symptoms and compression of the celiac artery by the median arcuate ligament was described clinically [2-6]. The syndrome is also referred to as celiac artery compression, celiac axis syndrome, median arcuate ligament syndrome, and Dunbar syndrome.

The median arcuate ligament is a fibrous arch that traverses the aorta and bridges the crura of the diaphragm (figure 1). Typically, the celiac axis branches from the abdominal aorta (figure 2) below the median arcuate ligament (between T11 and L1), but wide variation in the location of the celiac origin has been reported [7]. A higher or lower origin of the celiac axis may be prone to compression. A subset of patients (approximately 10 percent) have an abnormally positioned median arcuate ligament that appears to compress an otherwise normally positioned celiac artery [8]. Compression of the celiac artery by the median arcuate ligament is accentuated during expiration as the median arcuate ligament moves cranially and relieved during inspiration [9].

                           

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Literature review current through: Mar 2017. | This topic last updated: Feb 02, 2017.
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