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Coeliac artery compression syndrome

Coeliac artery compression syndrome is also known as coeliac axis syndrome, median arcuate ligament syndrome and Dunbar syndrome. It is characterised by upper abdominal angina secondary to compression of the coeliac trunk by the diaphragmatic crurae.


The median arcuate ligament is the fibrous arch that unites the diaphragmatic crura on either side of the aortic hiatus. In some people, this ligament has a low insertion point and may compress the coeliac trunk. Although commonly asymptomatic, it may cause ischaemic-type epigastric pain. The typical age of presentation is 20 to 40 year old.

Clinical presentation

  • mostly asymptomatic
  • chronic abdominal pain
  • pain relieved in standing position and aggravated by supine position

Radiographic features

Diagnosis is made via CT angiography or conventional angiography which demonstrates a focal stenosis that has a characteristic hooked appearance due to indentation of the coeliac trunk on its superior surface. Prominent gastroduodenal artery and common hepatic artery are noted. It is important to note that superior indentation of the coeliac trunk may be seen in normal people if imaging is acquired in expiration. The imaging findings must therefore be correlated with the clinical history.

The hooked appearance of the stenosis and the younger presenting age of the patient distinguishes this syndrome from the main differential diagnosis of atherosclerotic disease.


Symptomatic patients are treated with surgical decompression. This is usually performed laparoscopically by dividing the median arcuate ligament.

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