Surgical treatment of Dunbar syndrome

Abstract

Dunbar syndrome or celiac artery compression syndrome is an infrequently described clinical condition with poorly defined diagnostic criteria and an obscure pathophysiology. It is usually associated with an extrinsic compression upon the celiac axis near its takeoff from the aorta by fibrous diaphragmatic bands or sympathetic neural fibers. The authors report the case of a 70-year-old male patient presenting with nausea, epigastric pain, and weight loss. An aortography showed a compression of the celiac trunk. A preliminary attempt at percutaneous transluminal angioplasty and stenting proved unsuccessful. The patient became asymptomatic and his clinical condition improved after surgical release of the celiac trunk by partial section of the arcuate ligament of the diaphragm and with resection of the neural, fibrotic, and lymphatic tissues surrounding the aortic and visceral vessels. The purpose of this report is to discuss the indications and the therapeutic options of this syndrome.

Celiac artery compression: Dunbar syndrome

“…However, the introduction of MSCTA has enabled acquisition of thinner images, providing increased resolution, improved lesion detection, and excellent multiplanar reconstructions. 7 Since stenosis is respiratory-dependent and becomes more obvious with deep expiration, respiratory maneuvers are needed for diagnosis. The classic hook-like downward displacement followed by a dilatation of the celiac artery is a typical finding.…”

Laparoscopic Treatment of Celiac Axis Compression Syndrome: Case Report

“…Some authors suggested that the clinical manifestations are caused by ischemia secondary to the reduction of blood flow through the stenotic celiac axis 2 , 3 , 7 . However, others claimed that pain originates from direct compression of celiac ganglia 5 , 8 .…”

“…In the past, celiac axis compression syndrome was diagnosed by conventional angiography 5 . Lateral projection of aortography was the first choice to identify the celiac axis stricture.…”

“…The available evidence demonstrates that both laparoscopic and open ligament release associated with celiac ganglionectomy are effective in provide celiac artery revascularization and sustained symptom relief in the majority of patients with the syndrome 2 , 3 , 5 . The laparoscopic approach is feasible, safe, and successful, if performed by experienced laparoscopic surgeons.…”

“…The median arcuate ligament usually comes into contact with the aorta above the origin of the celiac axis. However, in some individuals, the it may be abnormally low and passes in front of the celiac axis, causing its compression, which is named median arcuate ligament syndrome 5 .…”