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. 2013;4(10):882-5.
doi: 10.1016/j.ijscr.2013.06.021. Epub 2013 Jul 26.

Laparoscopic treatment of celiac axis compression syndrome (CACS) and hiatal hernia: Case report with bleeding complications and review

Lorenzo di Libero  1 , Antonio Varricchio, Ernesto Tartaglia, Igino Iazzetta, Alberto Tartaglia, Antonella Bernardo, Rosanna Bernardo, Giovangiuseppe Triscino, Domenico Lo Conte
Affiliations

Laparoscopic treatment of celiac axis compression syndrome (CACS) and hiatal hernia: Case report with bleeding complications and review

Lorenzo di Libero et al. Int J Surg Case Rep. 2013.

Abstract

Introduction: Median arcuate ligament (MAL) malposition is a rare cause of celiac axis compression syndrome (CACS) or Dunbar syndrome.

Presentation of case: A 26-year-old female presented with severe postprandial epigastric pain, weight loss, heartburn and regurgitation unresponsive to medical therapy. CT angiography and duplex ultrasound demonstrated the MAL crossing anterior to the celiac artery (CA). Reconstructions demonstrated CA compression, while the superior mesenteric artery (SMA) was normal. The MAL was laparoscopically divided, releasing the celiac axis. A concomitant Nissen fundoplication was performed. At 3-months follow-up, the CT-scan demonstrated no evidence of CACS with complete symptom resolution.

Discussion: Dunbar's syndrome can be treated with endovascular surgery, laparoscopic MAL division or vascular surgery.Six anatomical and morphologic variations of aortic and esophageal hiatus are described. The result of the analysis of these anatomical data leads to the conclusion that hiatus hernia, Dunbar's syndrome and GERD have a common etiopathogenesis and physiopathology.

Conclusion: Laparoscopic treatment is useful and feasible in centers with experience in majorlaparoscopic surgery with reduced invasiveness, better cosmetic effect and shorter postoperative course.

Keywords: Dunbar's syndrome; Hiatal hernia; Laparoscopic treatment of CACS; Median arcuate ligament.

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Figures

Fig. 1
Fig. 1
Preoperative Eco-color-doppler of aorta and celiac trunk preoperative during inspiration and expiration.
Fig. 2
Fig. 2
AngioTc showing the preoperative angle formed by aorta and celiac trunk and its postoperative increase during follow up. Abbreviations: MAL, medium arcuate ligament; CACS, celiac artery compression syndrome; GERD, gastroesophageal reflux disease.
See this image and copyright information in PMC

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