Presentation
Chronic, recurrent epigastric abdominal pain, especially postprandial and weight loss
Patient Data
Age: 20 years
Gender: Female
From the case:
Median arcuate ligament syndrome (Dunbar syndrome)
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Doppler study of celiac artery :
An expiratory exam shows a velocity of 162 cm/s.
During inspiration, the following features are evident:
- increased systolic velocity (280 cm/s) with aliasing artifact
- increased end-diastolic velocity (90 cm/s).
- increased celiac artery compression (indentation of upper aspect)
- large deflection angle between inspiration and expiration
Doppler ultrasound features suggest celiac axis compression.
From the case:
Median arcuate ligament syndrome (Dunbar syndrome)
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CT scan performed in the mid position between inspiration and expiration:
- asymmetric stenosis of celiac trunk origin due to compression of the superior aspect of the artery by the arcuate ligament
- post-stenotic dilatation
Case Discussion
The following should be considered if celiac artery compression syndrome is suspected:
- it is a rare condition
- in this case, it presented as chronic postprandial abdominal pain
- narrowing of the celiac trunk at the diaphragm is non-specific and commonly seen in asymptomatic patients
- imaging findings should be correlated with the clinical history
- treatment is with surgical decompression
Laparoscopic surgical decompression was done for this patient with symptomatic improvement after surgery.
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