Das Kompressionssyndrom des Truncus coeliacus: Röntgenologisch-angiographisches Phänomen oder Ursache ischämischer abdomineller Beschwerden?

Abstract

Compression of the celiac trunk commonly occurs in young men and women as well. Most of the patients suffering from this rare disease derive from a large pool of people having diffuse and chronic abdominal complaints including epigastric pain, postprandial abdominal pain and diarrhea leading to weight loss. Aim of the study was the finding of true criteria which can guarantee a successful operative procedure. A major issue in preoperative assessment is color flow Duplex imaging of the celiac axis. The most important finding aside from clinical symptoms is a peak flow in the celiac axis of more than 200 cm/s during inspiration and expiration position of the diaphragm. In addition arteriography of the celiac axis and superior mesenteric artery (SMA) showing a steal phenomenon is essential. Because of the rareness of the disease "only" 15 patients were operated on including intraoperative balloon dilatation of the celiac trunk. 93 % had a long term follow up success. Normal values of peak flow velocity in the mesenteric arteries were determined in more than one hundred healthy persons and compared to findings in the literature which were nearly identical. As a result of the study it could be shown that a successful outcome of the operative procedure can be expected when certain essential criteria are observed: 1. peak flow velocity in the celiac trunk higher than 200 cm/s during in- and expiration 2. steal effect via pancreatic arcades from the superior mesenteric artery documented by Duplex ultrasound and arteriography 3. triad of symptoms: epigastric pain, postprandial pain and weight loss of more than 5 kg. Special emphasis is given to the possible occurrence of severe complications after liver transplantations and pancreatic surgery, if the diagnosis "median arcuate ligament compression" is not known.