Mucs Mihály, Székely Iván, Illés Iván, Juhász Arpád, Paál Balázs, Sárkány Agnes, Madácsy László, Altorjay Aron
Fejér Megyei Szent György Kórház, Altalános Sebészeti Osztály, Székesfehérvár.
Orv Hetil. 2007 Sep 16;148(37):1763-6. doi: 10.1556/OH.2007.28126.
Celiac trunk compression in few percentages of the cases can cause chronic abdominal pain that shows no connection with eating.
Detailed preoperative examinations showed significant, segmental stenosis of the celiac trunk, caused by outer compression of a tendonous arc of diaphragm, in the background of abdominal pain and mesenteric ischemia of a 58-year-old woman. After preparation we have executed the surgery by removing a tight ring, located at around 8-10 mm from the origin of trifurcation, and a part of the celiac ganglion. The patient was dismissed from our hospital 6 days after surgery in good general condition.
The abdominal pain can normally be the consequence of mesenteric ischemia. The root cause in most of the cases is the alteration of the particular artery. The outer compression is normally responsible only for a few percentages of the cases. In our case the problem was caused by a stronger tendonous part of the aortic hiatus. The first sign of this during the examination was a recognisable noise over the artery, which was caused by the poststenotic turbulent flow. Detailed radiological examinations executed based on this indeed proved this malfunction.
In case of unidentified abdominal pain we have to consider the possibility of the stenosis of the celiac trunk. By our case study we would like to call the attention to the importance of the auscultation over the abdomen, which is a relevant part of the basic physical examinations. When getting to the final diagnosis, apart from the duplex doppler sonography, we also used the results of angiography. The essence of the surgery was to get rid of the outer compression of the artery, which has to be done as soon as possible in order to avoid that compression causes degeneration of the artery itself.
少数情况下，腹腔干受压可导致与进食无关的慢性腹痛。
详细的术前检查显示，一名58岁女性在腹痛和肠系膜缺血的背景下，腹腔干存在明显的节段性狭窄，由膈肌腱弓的外部压迫所致。经过准备后，我们进行了手术，切除了距三叉分支起点约8 - 10毫米处的一个紧密环以及一部分腹腔神经节。患者术后6天出院，全身状况良好。
腹痛通常可能是肠系膜缺血的结果。在大多数情况下，根本原因是特定动脉的改变。外部压迫通常仅占少数病例的原因。在我们的病例中，问题是由主动脉裂孔较强的腱性部分引起的。检查期间的第一个迹象是动脉上可识别的杂音，这是由狭窄后湍流引起的。基于此进行的详细放射学检查确实证实了这一故障。
对于不明原因的腹痛，我们必须考虑腹腔干狭窄的可能性。通过我们的病例研究，我们想提请注意腹部听诊的重要性，这是基本体格检查的一个相关部分。在得出最终诊断时，除了双功多普勒超声检查外，我们还使用了血管造影的结果。手术的关键是消除动脉的外部压迫，必须尽快进行，以避免压迫导致动脉本身退变。
