title: Laparoscopic treatment of celiac axis compression syndrome (CACS) and hiatal hernia: Case report with bleeding complications and review.
abstract: BACKGROUND
  Median arcuate ligament (MAL) malposition is a rare cause of celiac axis compression syndrome (CACS) or Dunbar syndrome.
  
  
  METHODS
  A 26-year-old female presented with severe postprandial epigastric pain, weight loss, heartburn and regurgitation unresponsive to medical therapy. CT angiography and duplex ultrasound demonstrated the MAL crossing anterior to the celiac artery (CA). Reconstructions demonstrated CA compression, while the superior mesenteric artery (SMA) was normal. The MAL was laparoscopically divided, releasing the celiac axis. A concomitant Nissen fundoplication was performed. At 3-months follow-up, the CT-scan demonstrated no evidence of CACS with complete symptom resolution.
  
  
  CONCLUSIONS
  Dunbar's syndrome can be treated with endovascular surgery, laparoscopic MAL division or vascular surgery.Six anatomical and morphologic variations of aortic and esophageal hiatus are described. The result of the analysis of these anatomical data leads to the conclusion that hiatus hernia, Dunbar's syndrome and GERD have a common etiopathogenesis and physiopathology.
  
  
  CONCLUSIONS
  Laparoscopic treatment is useful and feasible in centers with experience in majorlaparoscopic surgery with reduced invasiveness, better cosmetic effect and shorter postoperative course.
authors: Unità Funzionale di Chirurgia Generale e Specialistica, Clinica Sanatrix, Via San Domenico 31, Napoli, Direttore, Dott Alberto Tartaglia, Italy. Electronic address: diloren1974@libero.it.
authors: Lorenzo
authors: L
authors: di Libero
authors: Antonio
authors: A
authors: Varricchio
authors: Ernesto
authors: E
authors: Tartaglia
authors: Igino
authors: I
authors: Iazzetta
authors: Alberto
authors: A
authors: Tartaglia
authors: Antonella
authors: A
authors: Bernardo
authors: Rosanna
authors: R
authors: Bernardo
authors: Giovangiuseppe
authors: G
authors: Triscino
authors: Domenico Lo
authors: DL
authors: Conte
keywords: Dunbar's syndrome; Hiatal hernia; Laparoscopic treatment of CACS; Median arcuate ligament
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