title: Laparoscopic treatment of celiac artery compression syndrome in children and adolescents.
abstract: BACKGROUND
  The celiac artery compression syndrome (CACS) is a rarely diagnosed disorder, which is characterized by chronic abdominal pain and vegetative symptoms. The role of surgical treatment in celiac artery decompression has been discussed controversially by numerous authors. After first casuistic descriptions of a laparoscopic treatment in adults we established this novel minimally invasive procedure for treatment in children and adolescents.
  
  
  METHODS
  Between 2005 and 2014 we operated 58 patients (47 female, 11 male) from 7 to 25 years who had been diagnosed with celiac artery compression. The patients presented with severe chronic abdominal pain, vegetative symptoms and a reduced quality of life. Doppler sonography showed an increased blood flow velocity of the celiac artery with maximum of 190 - 450 cm/s (mean 259 cm/s).MR angiography demonstrated a characteristic hook-shaped appearance of the celiac artery with severe localized compression.
  
  
  RESULTS
  All patients underwent laparoscopic decompression of the celiac artery. We observed complications in 3 patients (5,2 %). Postoperatively all patients (100 %) were immediately free of abdominal pain. Doppler sonography showed a marked reduction in celiac blood flow velocity to 70 - 190 cm/s postoperatively (mean 178 cm/s). A return of vessel diameters to normal dimensions was documented by postoperative MR angiography. During a median follow up of 62 months we observed a recurrence of the celiac artery compression in 4 patients (6,9 %).
  
  
  CONCLUSIONS
  Laparoscopic treatment of celiac artery compression syndrome offers a novel, safe, reliable and, compared to open surgery, less invasive approach. The surgical treatment is indicated in patients with characteristic symptoms and typical findings at Doppler sonography and MRA after exclusion of other abdominal pathologies. The work-up of chronic abdominal pain in children and adolescents should include a color Doppler sonography to look for celiac artery compression.
authors: 1 Department of Pediatric Surgery and Pediatric Urology, HELIOS Klinikum Erfurt, Germany.
authors: Annegret
authors: A
authors: Klimas
authors: Andreas
authors: A
authors: Lemmer
authors: Hendrik
authors: H
authors: Bergert
authors: Michael
authors: M
authors: Brodhun
authors: Thomas
authors: T
authors: Scholbach
authors: Kay
authors: K
authors: Großer
mesh_terms: D000293:Adolescent; D000328:Adult; D001783:Blood Flow Velocity; D002445:Celiac Artery / Q000002:abnormalities* / Q000000981:diagnostic imaging / Q000473:pathology / Q000503:physiopathology / Q000601:surgery; D002648:Child; D003251:Constriction, Pathologic / Q000175:diagnosis / Q000503:physiopathology / Q000601:surgery*; D019299:Decompression, Surgical / Q000379:methods*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D010535:Laparoscopy / Q000379:methods*; D018810:Magnetic Resonance Angiography; D008297:Male; D000074742:Median Arcuate Ligament Syndrome; D012189:Retrospective Studies; D016896:Treatment Outcome; D018615:Ultrasonography, Doppler, Color; D055815:Young Adult
keywords: Chronic abdominal pain; Dunbar syndrome; compression of the celiac artery; laparoscopic decompression of the celiac artery; median arcuate ligament syndrome