The celiac axis compression syndrome. Report of 5 cases

An ongoing debate in the literature discusses whether compression of the celiac axis (CA) and/or the superior mesenteric artery (SMA) by the arcuate ligament of the diaphragm may be responsible for a clinical syndrome. Five patients with postprandial epigastric pain and weight loss, with a loud systolic bruit in the epigastric region are described. In 4 cases, no other obvious explanation for the complaints was present except compression of the CA and SMA by the arcuate ligament of the diaphragm as shown on angiography. One patient had cholecystolithiasis. Two patients suffered from thrombosis in the CA with major stenosis of the SMA. In 3 cases, solitary stenosis of the CA was present. In 3 cases, important collateral circulation was seen, and 1 patient had possibly ischemic gastric ulcers indicating the ischemic nature of the complaints. Vascular reconstruction was done in 4 patients. One patient with a stenosis of less than 50% underwent cholecystectomy and was free of complaints thereafter. All other 4 patients were free of complaints after the operation. The CA compression syndrome should be considered in the differential diagnosis of patients with upper abdominal pain, weight loss and a loud systolic bruit in the epigastric region.