López CJA, Vera KAC, Plasencia CE, García AG, López PJA

Language: Spanish
References: 9
Page: 176-179
PDF size: 210.42 Kb.

ABSTRACT

Introduction: Middle arcuate ligament syndrome, also known as celiac trunk compression syndrome, is a rare entity, associated with postprandial chronic epigastric pain and weight loss. The syndrome occurs when the median arcuate ligament presents an anatomical variation and compresses the celiac trunk decreasing blood flow to the stomach. It has an incidence of two per 100,000 patients with upper recurrent and nonspecific abdominal pain. Case presentation: A 33-year-old male patient who presented with recurrent chronic abdominal pain for more than four years, as well as gastroesophageal reflux, for which he underwent five antireflux surgical procedures, managing to correct the gastroesophageal reflux, but without improvement of the abdominal pain. Two years after the last procedure, the patient reported postprandial abdominal pain, weight loss and sitophobia. He was evaluated in our hospital where complete laboratory tests were performed in addition to the contrast esophago-gastroduodenal study, endoscopy of the upper gastrointestinal tract, esophageal manometry, pH monitoring test and contrasted abdominal tomography where there was no evidence of pathological data associated with the clinical presentation subsequently, abdominal angiotomography and assessment by algology were performed, finally compression of the celiac trunk was diagnosed. The patient was laparoscopically approached and the medial arcuate ligament was sectioned. His postoperative evolution was favorable with a hospital stay of 48 hours. Again it was reassessed by algology confirming complete remission of pain. Conclusions: The compression of the celiac trunk is a rare entity that must be taken into account as a cause of chronic and recurrent abdominal pain that does not yield to conventional treatments. The laparoscopic approach is a safe and effective option for the treatment of this pathology.

REFERENCES

1. Schiappacasse FG, Maldonado SI, Varela UC, Müller CK, Ortiz VJ. Síndrome del ligamento arcuato medio. Rev Chil Radiol. 2014; 20: 149-155.

2. Petrella S, Prates JC. A review on the celiac trunk compression syndrome: some anatomic clinical-surgical aspects. Int J Morphol. 2008; 26: 293-304.

3. San Norberto E, Montes J, Romero A, Núñez E, Vaquero C. Síndrome del ligamento arcuato medio: a propósito de tres casos y revisión de la literatura. Angiología. 2012; 64: 167-172.

4. Harjola PT. A rare obstruction of the coeliac artery. Report of a case. Ann Chir Gynaecol Fenn. 1963; 52: 547-550.

5. Dunbar JD, Molnar W, Beman FF, Marable SA. Compression of the celiac trunk and abdominal angina. Am J Roentgenol Radium Ther Nucl Med. 1965; 95: 731-744.

6. Gander S, Mulder DJ, Jones S, Ricketts JD, Soboleski DA, Justinich CJ. Recurrent abdominal pain and weight loss in an adolescent: celiac artery compression syndrome. Can J Gastroenterol. 2010; 24: 91-93.

7. Pozzo-Salvatierra BL, Kimura-Fujikami K. Síndrome de compresión del ligamento arcuato medio en angiotomografía computada multicorte. Anales de Radiología México. 2014; 13: 171-175.

8. Horton KM, Talamini MA, Fishman EK. Median arcuate ligament syndrome: evaluation with CT angiography. Radiographics. 2005; 25: 1177-1182.

9. Baccari P, Civilini E, Dordoni L, Melissano G, Nicoletti R, Chiesa R. Celiac artery compression syndrome managed by laparoscopy. J Vasc Surg. 2009; 50: 134-139.