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 distort and 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.
- mostly asymptomatic
- chronic abdominal pain
- pain relieved in standing position and aggravated by supine position
Diagnosis is made via CT angiography or conventional angiography which demonstrates a focal stenosis that has a characteristic hooked appearance due to the indentation of the coeliac trunk on its superior surface. 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.
Prominent gastroduodenal and common hepatic arteries may be seen.
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.
Treatment and prognosis
Symptomatic patients are treated with surgical decompression. This is usually performed laparoscopically by dividing the median arcuate ligament.
- 1. Horton KM, Talamini MA, Fishman EK. Median arcuate ligament syndrome: evaluation with CT angiography. Radiographics. 25 (5): 1177-82. doi:10.1148/rg.255055001 - Pubmed citation
- 2. Muqeetadnan M, Amer S, Rahman A et-al. Celiac artery compression syndrome. Case Rep Gastrointest Med. 2013;2013: 934052. doi:10.1155/2013/934052 - Free text at pubmed - Pubmed citation