[New therapeutic approach in the celiac trunk compression syndrome]

Etiology and treatment of the coeliac compression syndrome remains controversial. The external compression, near the origin of the truncus coeliacus and the poststenotic dilatation is well demonstrated by angiography on a lateral projection. The development of collaterals like the pancreaticoduodenal and gastroduodenal artery can be assessed on a frontal view. The grading of the stenosis as well as the direction of the flow in these artery can be measured with the duplex sonography. These investigations show a steal syndrome: blood coming from the mesenteric artery irrigate the common hepatic artery through the collaterals. The flow in the common hepatic artery is therefore retrograde. We used an original technique to correct this flow pattern in the case of a 52-year-old patient: after dividing the arcuate ligament, we reduced the vascular territory of the truncus coeliacus with the proximal ligation of the splenic artery. The duplex sonography shows postoperatively the suppression of the steal syndrome with a normal flow pattern in the hepatic artery despite minimal change in the stenosis of the truncus coeliacus. The patient remained asymptomatic since the operation. We concluded that an angioplasty or reimplantation of the truncus coeliacus is unnecessary to correct the steal syndrome. A normal flow can be provided by a stenotic truncus coeliacus once the splenic artery has been ligated.