CASE HISTORY – October 2020

Coeliac artery compression syndrome as a cause of chronic abdominal pain in children and adolescents. Two case histories

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Coeliac artery (CA) compression syndrome is an uncommon disorder defined as recurrent abdominal pain related to compression of the coeliac artery by the median arcuate ligament (MAL). CA compression is clinically characterized by various symptoms, leading to postprandial abdominal pain. Definitive diagnosis requires vascular imaging to confirm compression (duplex ultrasound with respiratory manoeuvres combined with advanced vascular imaging). CA compression syndrome is inferred by differences in end-inspiratory versus end-expiratory imaging. During expiration, CA compression worsens and blood flow velocity increases; during inspiration compression is relieved. Asymptomatic patients with an incidental diagnosis and patients whose symptoms are not consistent with the findings of imaging should not be treated. For treatment of symptomatic patients with inspiratory and expiratory confirmed CA compression, laparoscopic decompresson is necessary. Two cases of TC compression syndrome are discussed.