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

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.