Celiac Artery Compression Syndrome

Celiac artery compression syndrome is a rare disorder characterized by episodic abdominal pain and weight loss. It is the result of external compression of celiac artery by the median arcuate ligament. We present a case of celiac artery compression syndrome in a 57-year-old male with severe postprandial abdominal pain and 30-pound weight loss. The patient eventually responded well to surgical division of the median arcuate ligament by laparoscopy. 1. Introduction Celiac artery compression syndrome also known as median arcuate ligament syndrome is a rare cause of abdominal pain and weight loss. It is caused by compression of the celiac artery by the median arcuate ligament. We report a case of a 57-year-old male who presented to us with this rare diagnostic challenge. Various imaging techniques such as duplex ultrasound, magnetic resonance angiography, computerized tomography angiogram, and visceral angiography can be used to diagnose this condition. Surgical decompression of the celiac artery by division of the median arcuate ligament has been shown to be very effective. 2. Case Report A 57-year-old male with past history significant for hepatitis C and chronic abdominal pain with 50 admissions in various hospitals over the last 2 years presented with worsening epigastric and left upper quadrant pain as well as a 30-pound weight loss over one year (Figure 1). The pain was sharp, constant, 10/10 in severity, and radiating to the back and chest. It was aggravated by deep inspiration and was associated with nausea and diarrhea. He had about 3-4 loose nonbloody bowel movement per day. He also reported decreased appetite. There was no reported history of fever, chills, cough, shortness of breath, or chest pain. Figure 1: Cachectic patient (as a result of his 30-pound weight loss). A detailed exam was notable for cachexia and normal vital signs. S1 and S2 were audible with no murmurs or gallop. Lungs were clear to auscultation. Abdomen was flat, nontender with normal bowel sounds. He had 5/5 strength bilaterally with no sensation abnormalities. He was extensively evaluated in the past; he recently had a normal colonoscopy and esophagogastroduodenoscopy. Endoscopic ultrasound demonstrated a normal common bile duct with no filling defects. Pancreas showed no atrophy, calcification, or pseudocyst. Labs on admission showed normal electrolytes hemoglobin 10？g/dl, platelets 120 × 109/L, and white blood cells 6.8 × 109/L. Liver function tests were elevated (alanine aminotransferase 216？U/L, aspartate aminotransferase 414？U/L, and alkaline phosphatase 191？U/L) likely