CASE REPORTS   

Panminerva Medica 2002 March;44(1):69-72

Copyright © 2009 EDIZIONI MINERVA MEDICA

language: English

Successful treatment of recurrent celiac axis compression syndrome. A case report

Cinà C. S., Safar H.

From the Division of Vascular Surgery Department of Surgery Hamilton Health Sciences Corporation General Campus, McMaster University Hamilton, Ontario, Canada

The ­celiac ­axis com­pres­sion syn­drome is char­ac­ter­ized by the clin­i­cal ­triad, epi­gas­tric ­pain, ­weight ­loss and post­pran­di­al eme­sis. The aetio­lo­gy is attrib­ut­ed to inter­mit­tent ischae­mia of the fore­gut. The ­results of ­three dif­fer­ent modal­ities of treat­ment, trans­lu­mi­nal dil­a­ta­tion, sur­gi­cal divi­sion of the ­median arcu­ate lig­a­ment, and by­pass sur­gery in a ­patient ­with recur­rent ­celiac ­artery com­pres­sion syn­drome are ­reviewed. A 62-­year-old wom­an ­with a pre­vi­ous par­tial gas­trec­to­my pre­sent­ed ­with post­pran­di­al abdom­i­nal ­pain and ­marked ­weight ­loss. Investigations for gas­troin­tes­ti­nal ­tract pathol­o­gy ­were all neg­a­tive. Angiography ­revealed com­pres­sion of the ­celiac ­axis and an angio­plas­ty was unsuc­cess­ful. The ­patient under­went sur­gi­cal divi­sion of the ­median arcu­ate lig­a­ment ­with com­plete ­relief of symp­toms, ­which ­recurred ­four ­months lat­er. Angiography dem­on­strat­ed a resten­o­sis of the ­celiac ­axis. An aor­to-­celiac ­artery ­bypass was ­done ­with com­plete and per­sis­tent ­relief of symp­toms at ­four ­years fol­low-up. This is a ­rare syn­drome, ­which ­requires pre­dis­pos­ing ana­tom­ic fac­tors. In ­this ­patient, a pre­vi­ous par­tial gas­trec­to­my ­with gas­tro­jej­u­nos­to­my ­roux-en-y ­caused dis­con­nec­tion of the pan­crea­ti­co-duod­en­al net­work. Scarring ren­ders inef­fec­tive ­less inva­sive inter­ven­tions. Bypass sur­gery is the treat­ment of ­choice and ­offers dur­able ­results.