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 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, especially postprandial
  • pain relieved in standing position and aggravated by supine position
  • weight loss

Doppler ultrasound can be a useful noninvasive diagnostic tool. A peak systolic velocity over the compressed segment of the coeliac artery of greater than 200 cm/s during expiration has a reported sensitivity and specificity of 75% and 89%, respectively 4

CT angiography and conventional angiography are considered to be the gold standard imaging modalities. These modalities demonstrate a focal stenosis that has a characteristic hooked appearance due to the indentation of the coeliac trunk on its superior surface. This characteristic hooked appearance of the stenosis, as well as the younger presenting age of the patient, distinguishes this syndrome from the main differential diagnosis of atherosclerotic disease.

It is important to note that superior indentation of the coeliac trunk may be seen in normal people if imaging is acquired in expiration. Therefore imaging for accurate diagnosis should ideally be performed in the end-inspiratory phase 4. Furthermore, imaging findings must also be correlated with the clinical history.

Additional features that may be appreciated include post stenotic dilatation, prominent collaterals, such as the gastroduodenal and common hepatic arteries, and thickening of the median arcuate ligament. A thickness of the median arcuate ligament of greater than 4 mm is considered abnormal 4.

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

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Article information

rID: 1143
Section: Syndromes
Synonyms or Alternate Spellings:
  • Dunbar syndrome
  • Median arcuate ligament syndrome
  • Coeliac axis syndrome
  • Celiac artery compression syndrome
  • Dunbar's syndrome
  • MAL syndrome

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