Laparoscopic Treatment of Celiac Axis Compression Syndrome: Case Report

Celiac axis compression syndrome, also known as median arcuate ligament syndrome or Dunbar syndrome, is a rare condition. This syndrome was first reported by Harjola in 19636. Dunbar described it as a clinical syndrome in his memorial paper in 19654. It is characterized by compression of the celiac axis by the median arcuate ligament of the diaphragm. The median arcuate ligament is a fibrous arch formed at the base of the diaphragm at the level of the 12th thoracic vertebra, where the left and right diaphragmatic crura join1. This fibrous arch forms the anterior aspect of the aortic hiatus, through which the aorta, thoracic duct, and azygos vein pass. 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 syndrome5. Some patients with this syndrome refer severe clinical manifestations such as postprandial abdominal pain, weight loss, and vomiting. The primary treatment modality for this condition is surgical division of its fibers. The traditional surgical approach has been through an upper abdominal laparotomy incision. Roayaie et al. in 2000 reported the first patient with celiac axis compression syndrome treated by laparoscopy access. Afterwards, several authors have demonstrated that the laparoscopic access may be employed with success to treat this condition8. To best of our knowledge, this is the first report of laparoscopic treatment of the celiac axis compression syndrome in Brazil.