[Celiac axis compression syndrome by the median arcuate ligament of the diaphragm. Definite surgical management].

The celiac axis compression syndrome caused by the median arcuate ligament of the diaphragm is an exceedingly rare clinical entity, coursing with postprandial abdominal pain, nausea, vomiting and weight loss. Despite the original description made some decades ago, its existence is still challenged by some authors, due to a weak clinicopathological correlation and inconstant results obtained with its surgical management. The authors report the case of a 35 years old female with the clinical presentation above described, who underwent an exhaustive investigation in gastroenterology, leading to the diagnosis, made by CT-scans and conventional angiography, of celiac axis compression syndrome by the median arcuate ligament of the diaphragm. A definitive surgical repair was performed, consisting in the ligament division, followed by resection and replacement of the celiac axis, by a 6 mms PTFE grafts. The post-operative course was uneventful and reviewed one month later, the patient was found in excellent condition and completely free of symptoms. Pathological studies of the celiac axis disclosed significant proliferative and degenerative lesions of the arterial wall, consequence of the compression mechanism, a fact that has not been reported in previous similar publications. The main feature of this unique clinical entity and its surgical management are discussed, based on a review of the most recent publications of the literature.