Celiac Artery Compression Syndrome (CACS): A Case Report and Review of the Literature

Authors

  • Anuwat Chantip Department of Surgery, Lampang Regional Hospital

Keywords:

Celiac artery compression syndrome, Median arcuate ligament, Dunbar syndrome

Abstract

Celiac artery compression syndrome (CACS), also known as Dunbar syndrome or median arcuate ligament syndrome (MALS), is a condition that can result from a fibrous ligament, the median arcuate ligament, passing superior to the celiac axis causing extrinsic compression or entrapment of sympathetic neural fibers near its takeoff from the abdominal aorta. This uncommon disorder is characterized clinically by the triad of postprandial abdominal pain, weight loss, and sometimes abdominal bruit. In the literature, most cases of CACS are from Western countries. The diagnosis is generally considered after more common conditions have been ruled out.  In particular, an extensive evaluation of GI tract and biliary system have been done in an effort to identify the cause of pain. For patients in whom celiac artery compression is suspected, the diagnosis requires vascular imaging with a respiratory maneuver to confirm CACS. The author reported a 27-year-old woman with CACS, along with results of cross-sectional CTA, 3D reconstruction, combined with intra-operative duplex ultrasound of the celiac artery to demonstrate stenosis, and an attempt at decompression by aggressive resection of median arcuate ligament and nerve fibers.

References

Harjola PT. A rare obstruction of the celiac artery. Report of a case. Ann Chir Gynaecol Fenn 1963;52:547-50.

Dunbar JD, Molnar W, Beman FF, Marable SA. Compression of the celiac trunk and abdominal angina. Am J Roentgenol Radium Ther Nucl Med 1965; 95:731-44.

Park CM, Chung JW, Kim HB, et al. Celiac axis stenosis: incidence and etiologies in asymptomatic individual. Korean J Radiol 2001;2:8-13.

Kazan V, Qu W, Al-Natour M, et al. Celiac artery compression syndrome: a radiological finding without clinical symptom? Vascular 2013; 21: 293-9.

Cusati DA, Noel AA, Gloviczki P, et al. Median arcuate ligament syndrome: a 20-year experience of surgical treatment. Presented at: 60th Annual Meeting of the Society for Vascular Surgery: June 1-4, 2006: Philadelphia, PA.

Jimenez JC, Harlander-Locke M, Dutson EP. Open and laparoscopic treatment of median arcuate ligament syndrome. J Vasc Surg 2012;56:869-73.

Reilly LM, Ammar AD, Stoney RJ, Ehrenfeld WK. Late results following operative repair for celiac artery compression syndrome. J Vasc Surg 1985;2:79-91.

Williams S, Gillespie P, Little JM. Celiac axis compression syndrome: Factors predicting a favorable outcome. Surgery 1985;98:879-87.

Ikeda O, Tamura Y, Nakasone Y, Yamashita Y. Celiac artery stenosis/occlusion treated by interventional radiology. Eur J Radio 2009;71:369-77.

Desmond CP, Roberts SK. Exercise-related abdominal pain as a manifestation of the median arcuate ligament syndrome. Scan J Gastro 2004;39:1310-3.

Watson WC, Sadikali F. Celiac axis compression. Experience with 20 patients and a critical appraisal of the syndrome. Ann Int Med 1977;86:278-84.

Horton KM, Talamini MA, Fishman EK. Median arcuate ligament syndrome evaluation with CT angiography. Radiographics 2005;25: 1177-82.

Grotemeyer D, Duran M, Iskandar F, et al. Median arcuate ligament syndrome vascular surgical therapy and follow-up of 18 patients. Lang Arch of Surg 2009;394:1085-92.

Roayaie S, Jossart G, Gitlitz D, et al. Laparoscopic release of celiac artery compression syndrome facilitated by laparoscopic ultrasound scanning to confirm restoration of flow. J Vasc Sur 2000;32:814-7.

Baccari P, Civilini E, Dordoni L, et al. Celiac artery compression syndrome managed by laparoscopy. J Vasc Sur 2009;50:134-9.

Weber JM, Boules M, Fong K, et al. Median arcuate ligament syndrome is not a vascular disease. Ann Vasc Surg 2016;30:22-7.

Cina CS, Safar H. Successful treatment of recurrent celiac axis compression syndrome. A case report. Panminerva Med 2002;44:69-72.

Delis KT, Gloviczki P, Altuwaijri M, McKusick MA. Median arcuate ligament syndrome: open celiac artery reconstruction and ligament division after endovascular failure. J Vasc Surg 2007;46:799-802.

Takachi TJ, Livesay JJ, Reul GJ, Cooley DA. Celiac compression syndrome: tailored therapy based on intraoperative finding. J Am Coll Surg 1996;183:606-10.

Downloads

Published

2020-06-30

How to Cite

1.
Chantip A. Celiac Artery Compression Syndrome (CACS): A Case Report and Review of the Literature. Thai J Surg [Internet]. 2020 Jun. 30 [cited 2024 Dec. 13];41(2):46-51. Available from: https://he02.tci-thaijo.org/index.php/ThaiJSurg/article/view/240636

Issue

Section

Case Reports