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Celiac artery compression syndrome(CACS), also known as median arcuate ligament syndrome (MALS), is a rare cause of recurrent abdominal pain. CACS is seldom reported in oriental countries or regions. To report the early diagnosis of a CACS due to epigastric bruits and review the management strategies of this rare disease.
A 23-year-old thin female patient was admitted to ED with abdominal pain, nausea and diarrhea lasting for 2 days. Tracing back her history, the patient denied any significant systemic disease. A general physical examination revealed epigastric tenderness without peritoneal irritation signs and epigastric bruit that was amplified with expiration, other systems were normal. Her white blood cell count was 12,550/mm3, granulocyte proportion was 83.4%, plasma D-dimer values was 1.0mg/L FEU. Antibiotic therapy, esomeprazole and anisodamine were administered intravenously, her abdominal pain was recurrent after eating,. The abdominal computed tomographic angiography(CTA) was demonstrated focal stenosis of the proximal celiac artery, the “fish hook” appearance was seen in the proximal portion of celiac artery, with a poststenotic dilatation in the distal portion.
The patient was subsequently seen by a vascular surgeon and conservative medical treatment for 1 week. Her abdominal pain was gradually improved and discharged. The patient was followed up after 15 days, her abdominal pain was recurrent and treated by laparoscopic decompression in the United States.
CACS is an uncommon vascular disease resulting from celiac artery compression by the median arcuate ligament. Vascular steal of blood flow by larger collateral vessels may lead to symptoms of celiac artery compression in patients with an occluded or compressed celiac trunk. The symptoms of CACS are usually nonspecific and are easily misdiagnosed as functional dyspepsia, peptic ulcer disease, or gastropathy. Both CTA and magnetic resonance angiography(MRA) have been used to diagnose CACS. In this patient, she is suspected of having CACS due to epigastric bruits. The early accurate diagnosis is based on experience with increased awareness of CACS. There are no guidelines to ensure the proper treatment of patients with CACS because of its low incidence. A symptomatic case maybe required manage by releasing the celiac artery from extrinsic compression such as surgical treatment and a laparoscopic approach, but It is controversial. In conclusion, We suggest that CTA should be done leading to diagnose CACS in patients with recurrent abdominal pain of exclusion to other causes of upper gastrointestinal pathology incorporating epigastric bruits.