Celiac artery compression syndrome: unusual cause of chronic abdominal pain

Celiac artery compression syndrome is characterised by abdominal pain, usually related to the ingestion of food coexisting with arteriographic evidence of extrinsic compression of the celiac artery by the median arcuate ligament of the diaphragm. It is usually associated with weight loss and often with an epigastric bruit. Presentation of the case: a 58 year old woman was referred because of epigastric pain, starting four months before. The pain, characterised as often debilitating was not strictly related to meals. She lost 5kg of weight. Upper endoscope revealed an H.p. associated gastritis, but neither eradication of bacteria nor antispasmodic agents and PPI therapy offered significant relief. On physical examination an epigastric bruit was detected. Blood chemistry and thyroid function test were all normal. Colonoscopy, selective enterography and abdominal CT scan didn't reveal any pathology. Her pains persisted and she lost another 5kg. On duplex sonography velocity of the flow was markedly elevated at the level of origin of the celiac artery, corresponding to significant stenosis. Abdominal angiography revealed that the stenosis was caused by external compression, characteristic for median arcuate ligament syndrome. At laparatomy the median arcuate ligament was tensely tethered over the celiac artery, and a prominent thrill was palpable in the distal celiac artery. The arcuate ligament was completely divided without ganglionectomy. After the operation, her abdominal pain has completely resolved and 3 months later she regained 6kg. Celiac artery compression syndrome is a rare disorder. The diagnosis depends on the elimination of other possible causes for abdominal pain and the knowledge that this curious syndrome does indeed exist. In well selected patients the celiac artery compression can be corrected with a safe, relatively simple surgical procedure resulting complete relief of the long standing debilitating pain and a dramatic improvement in the quality of life of the patients.